JHLT Open最新文献

{"title":"Safety and efficacy of sodium-glucose cotransporter 2 inhibitors in post-heart transplant patients: A multi-center retrospective cohort study","authors":"Josephine Harrington ,&nbsp;Alex Severino ,&nbsp;Lisa Yanek ,&nbsp;Nadia Fida ,&nbsp;Farhan Ishaq ,&nbsp;Farrah Al-Saffar ,&nbsp;Evelyn Song ,&nbsp;Katherine Clark ,&nbsp;Teresa De Marco ,&nbsp;H. Luise Holzhauser ,&nbsp;Amanda Vest ,&nbsp;Priya Umapathi","doi":"10.1016/j.jhlto.2025.100465","DOIUrl":"10.1016/j.jhlto.2025.100465","url":null,"abstract":"<div><h3>Background</h3><div>Despite compelling mechanistic and clinical data supporting the use of sodium glucose cotransporter 2 inhibitors (SGLT2i) in heart failure, chronic kidney disease (CKD), and type 2 diabetes (T2DM), the safety and efficacy of SGLT2i in patients with prior orthotopic heart transplant (OHT) patients remain underexplored, potentially due to concerns surrounding infection risk and kidney injury.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of patients receiving an SGLT2i following OHT at 7 large transplant centers between July 2016 and December 2023 to assess safety and tolerability. Key outcomes of interest included hospitalization attributed to SGLT2i use, genital/urinary tract (GU) infection, and acute kidney injury (AKI), as well as discontinuation of SGLT2i.</div></div><div><h3>Results</h3><div>Overall, 141 patients across 7 transplant centers were included in this cohort analysis. Patients had a median age of 61, and the median time from transplant was 5.3 years. Rates of hospitalization related to SGLT2i were low, occurring in 1.4% of the study population (2/141) at a rate of 0.007 events/person-year. GU infections occurred in 9.93% (14/141) of patients, and AKI within 30 days was observed in 20.59% (21/102 patients who had a complete dataset available for analysis). At the end of the observation period, 68.1% of patients remained on an SGLT2i, and 31.9% had discontinued their SGLT2i: 15.6% of patients discontinued their SGLT2i for medical reasons, most commonly AKI or GU infection.</div></div><div><h3>Conclusion</h3><div>Our results suggest that though discontinuation of SGLT2i use was high in patients post-OHT, the overall safety profile of the drug class was reassuring, with a low observed risk of hospitalization, kidney failure, or GU infection. Future larger prospective studies are needed to more fully elucidate the impact of SGLT2i on long-term outcomes in patients following OHT.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100465"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donation after circulatory death in adult congenital heart disease: A fragile match","authors":"Jose B. Cruz Rodriguez ,&nbsp;Deepak Acharya","doi":"10.1016/j.jhlto.2025.100414","DOIUrl":"10.1016/j.jhlto.2025.100414","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100414"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflecting on the potential impact of donor-derived Kaposi sarcoma in lung transplantation","authors":"Zsofia Rosselli","doi":"10.1016/j.jhlto.2025.100471","DOIUrl":"10.1016/j.jhlto.2025.100471","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100471"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary evidence to inform management of deceased potential thoracic organ donors after brain death","authors":"Federico Ciardi MBBS ,&nbsp;Chiara Magri MD ,&nbsp;Antonio Rubino MD ,&nbsp;Emily A. Vail MD, MSc","doi":"10.1016/j.jhlto.2025.100474","DOIUrl":"10.1016/j.jhlto.2025.100474","url":null,"abstract":"<div><div>Brain death triggers profound physiologic derangements that threaten organ viability and contribute to the persistent shortage of transplantable thoracic organs. This narrative review synthesizes contemporary evidence informing the management of deceased potential thoracic organ donors after brain death, focusing on clinical studies published over the past decade. We identified 14 trials addressing key aspects of donor management, including lung-protective ventilation strategies, prone positioning, targeted temperature management, hormonal supplementation, and cardiovascular support. Notable findings include validation of lung-protective ventilation with higher positive end-expiratory pressure improving lung recovery rates, observational evidence suggesting that prone position is associated with increased lung and heart procurement, and recent randomized trials demonstrating no benefit from routine levothyroxine administration even in hemodynamically unstable donors. Corticosteroid therapy appears to effectively reduce vasopressor requirements, while newer evidence supports the safety of lower-dose regimens with improved glycemic control. Despite these advances, significant knowledge gaps persist regarding optimal hemodynamic monitoring, vasopressor selection, and other fundamental management decisions. The fragmented nature of the donation and transplantation system presents unique challenges for evidence generation and implementation. Ongoing developments, including donor care units, international collaboration, and innovative trial designs, offer opportunities to address these gaps. This review provides intensivists with an evidence-based framework for optimizing donor management while highlighting priority areas for future research to increase the availability and quality of thoracic organs for transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100474"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of the geriatric nutritional risk index on waitlist mortality in adult patients listed for lung transplantation from donation after brain death","authors":"Gouji Toyokawa MD, PhD ,&nbsp;Miho Yamaguchi MD, PhD ,&nbsp;Takafumi Yamaya MD ,&nbsp;Takaki Aakamine MD, PhD ,&nbsp;Mitsuaki Kawashima MD, PhD ,&nbsp;Chihiro Konoeda MD, PhD ,&nbsp;Mototsugu Shimokawa PhD ,&nbsp;Masaaki Sato MD, PhD","doi":"10.1016/j.jhlto.2025.100424","DOIUrl":"10.1016/j.jhlto.2025.100424","url":null,"abstract":"<div><h3>Background</h3><div>The geriatric nutritional risk index (GNRI) was developed to assess nutritional status of elderly patients, and is a recognized prognostic factor in various diseases. However, its role in patients awaiting lung transplantation (LT) from donation after brain death (DBD) remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed adult patients registered for LT from DBD between January 2014 and July 2023. GNRI was calculated using the formula: (1.489 x serum albumin [g/dL]) + (41.7 x [current body weight / ideal body weight]). Its cut-off value was determined by receiver operating characteristic curve analysis for waitlist mortality. The primary objective was to clarify the association between GNRI and waitlist mortality.</div></div><div><h3>Results</h3><div>The study included 354 patients; 147 (41.5%) survived to receive LT, while 105 (29.7%) died on the waiting list. The GNRI cut-off value was 93.84, with an area under the curve of 0.623. The low GNRI group (n = 122 [34.5%]) had significantly lower body mass index (<em>P</em> &lt; 0.001), shorter 6-minute walk distance (<em>P</em> = 0.002), and higher need for oxygen supplementation (<em>P</em> = 0.015) compared to the high GNRI group (n = 232 [65.5%]). Multivariate analysis identified GNRI (<em>P</em> = 0.024), age (<em>P</em> = 0.047), sex (<em>P</em> = 0.013), 6-minute walk distance (<em>P</em> &lt; 0.001), forced vital capacity (<em>P</em> = 0.023), and disease category (<em>P</em> = 0.036), as significant independent prognostic factors for survival.</div></div><div><h3>Conclusions</h3><div>GNRI is a significant prognostic indicator for survival in patients awaiting LT from DBD, and may aid in pre-transplant evaluation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100424"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechano-energetic uncoupling in the right ventricle in pulmonary hypertension","authors":"Peng Zhang MD ,&nbsp;Reza Avazmohammadi PhD ,&nbsp;Kurt W. Prins MD, PhD ,&nbsp;Gaurav Choudhary MD","doi":"10.1016/j.jhlto.2025.100460","DOIUrl":"10.1016/j.jhlto.2025.100460","url":null,"abstract":"<div><div>Pulmonary Hypertension (PH) affects up to 1% of the world population and is commonly associated with cardiopulmonary diseases. Right ventricular (RV) dysfunction and failure in response to the persistently increased RV afterload are the main cause of the morbidity and mortality in PH. As PH progresses, there is uncoupling of the RV-pulmonary artery (PA), resulting in RV failure. Strategies to optimize RV-PA coupling so far have mainly focused on lowering RV afterload with fewer options available to increase RV contractility. Here, we provide a perspective that there exists another type of “uncoupling”, between energy production and mechanical work within the RV, that reflects the competition between contractility (demand) and metabolism (supply). This uncoupling is a result of increased myocardial stiffness in the RV in PH, along with decreased energy production. We propose that optimizing mechano-energetic uncoupling by decreasing stiffness and increasing energetic capacity would be important as we seek to target the failing RV to improve RV-PA coupling and ultimately outcomes in patients with PH.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100460"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid donor-specific single nucleotide variation detection by nanopore sequencing of ex vivo lung perfusate","authors":"Haruchika Yamamoto ,&nbsp;Jonathan Allen ,&nbsp;Adam Sundby ,&nbsp;Philip Zuzarte ,&nbsp;Shaf Keshavjee ,&nbsp;Jared Simpson ,&nbsp;Gavin W. Wilson ,&nbsp;Jonathan C. Yeung MD, PhD, FRCSC","doi":"10.1016/j.jhlto.2025.100433","DOIUrl":"10.1016/j.jhlto.2025.100433","url":null,"abstract":"<div><h3>Background</h3><div>Donor-derived cell-free DNA (ddcfDNA) has been shown to be useful in monitoring lung graft health, and single nucleotide variations (SNVs) between donor and recipient are used to identify ddcfDNA in post-transplant recipient blood. One limitation is the need to map donor or recipient SNVs prior to calculating %ddcfDNA. In this study, we use Nanopore sequencing of ex vivo lung perfusion perfusate cfDNA to map donor SNVs and validate it using standard short-read whole genome sequencing (WGS). Methods: cfDNA was extracted from 11 clinical ex vivo lung perfusion perfusate samples and sequenced using a Nanopore sequencer. SNVs were identified by comparison to a reference genome and then filtered for homozygous calls overlapping the 1000 Genomes SNP database. Matching short-read WGS was performed on 6 matching samples to act as a gold standard. Following mapping, %ddcfDNA was calculated in cell-free DNA (cfDNA) collected from matching post-lung transplant recipient plasma using SNVs called by Nanopore vs SNVs called by short-read WGS and compared for accuracy.</div></div><div><h3>Results</h3><div>Nanopore sequencing yielded genomic data with a median coverage of 4.88x (range 2.27-8.79) using a single flow cell with a median run length of 72 hours. The median general error rate of the sequence was 5.55% (range 4.98%-6.49%), and the median number of SNV with a depth &gt; 3 and overlap with the 1000 Genomes SNP database was 246,993 (range 99,357-313,721). The positive predictive value of SNVs identified using 2X to 6X coverage cutoffs ranged from 66.6% to 96.9%, with a median value of 90.3% at 6X coverage. Correlation analysis showed a strong correlation between results by Nanopore sequencing and results by WGS for detecting %ddcfDNA in post-transplant plasma (R^2 = 0.996, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Despite the lower sequencing accuracy and depth obtained from Nanopore sequencing, a high positive predictive value can be achieved in a set of donor-specific SNVs when appropriately filtered by read depth and overlap with SNP databases. This demonstrates the potential for the use of Nanopore sequencing to generate personalized donor cfDNA maps for use in post-operative donor-derived plasma cfDNA identification.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100433"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermediate-term risk of cardiac allograft vasculopathy following heart transplantation from hepatitis C viremic donors in the era of direct-acting antiviral therapy","authors":"K. Paternostro,&nbsp;A. Birs,&nbsp;S. Aslam,&nbsp;E. Adler,&nbsp;K. Hong,&nbsp;N. Wettersten","doi":"10.1016/j.jhlto.2025.100416","DOIUrl":"10.1016/j.jhlto.2025.100416","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac allograft vasculopathy (CAV) is a leading cause of death in heart transplant (HTx) recipients. Chronic hepatitis C virus (HCV) infection has been associated with increased inflammation and accelerated CAV. The advent of direct-acting antiviral (DAA) therapy has renewed interest in transplanting HCV-viremic donors, though long-term outcomes remain limited.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of adult HTx recipients at UC San Diego from 2015 to 2019 who underwent routine intravascular ultrasound (IVUS) surveillance. Recipients were stratified by donor HCV nucleic acid amplification test (NAT) status. Donor-derived HCV infection was treated with DAA therapy. We used multivariable-adjusted Cox regression to evaluate the primary endpoint of developing CAV, defined as maximal intimal thickness (MIT) ≥ 0.5 mm, and endpoints of MIT ≥ 0.7 mm and a composite outcome of incident acute coronary syndrome, percutaneous coronary intervention (PCI), and all-cause mortality.</div></div><div><h3>Results</h3><div>Among 131 recipients, 22 received HCV NAT+ hearts. Baseline donor and recipient characteristics were similar, except for recipients of HCV NAT- hearts were younger (53.7 years vs 61.0 years; <em>P</em> = 0.022). Over a median follow-up of 6.6 years, HCV NAT+ status was not associated with a higher risk of CAV (MIT ≥ 0.5 mm: adjusted HR 0.89, 95% confidence interval (CI), 0.52-1.53; <em>p</em> = 0.673; MIT ≥ 0.7 mm: adjusted HR 0.91, 95% CI 0.51-1.61; <em>p</em> = 0.750), nor the composite outcome (adjusted HR 1.23, 95% CI, 0.45-3.40; <em>p</em> = 0.690).</div></div><div><h3>Conclusion</h3><div>In the modern DAA era, transplantation of HCV NAT+ donor hearts is not associated with increased risk of CAV or adverse clinical outcomes over intermediate-term follow-up.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abnormal spirometry 1 year after lung transplantation may identify patients at risk for chronic lung allograft dysfunction in a multicenter cohort","authors":"Alexander R. Graham MD, MHS ,&nbsp;Maria V. Grau-Sepulveda MD, MPH ,&nbsp;Jamie L. Todd MD, MHS ,&nbsp;Megan L. Neely PhD ,&nbsp;Laurie D. Snyder MD, MHS","doi":"10.1016/j.jhlto.2025.100473","DOIUrl":"10.1016/j.jhlto.2025.100473","url":null,"abstract":"<div><h3>Background</h3><div>Baseline lung allograft dysfunction (BLAD) is the failure to achieve predicted pulmonary function after lung transplantation. BLAD, as defined by abnormal spirometry at 12 months post-transplant (Spiro12M), has been associated with increased mortality and chronic lung allograft dysfunction (CLAD) in a single-center study. We sought to validate Spiro12M in a prospective multicenter study that included bilateral (BLTx) and single (SLTx) lung recipients.</div></div><div><h3>Methods</h3><div>The cohort included first lung recipients from 5 North American transplant centers participating in the Clinical Trials in Organ Transplantation-20 study. Abnormal Spiro12M was defined as a percent predicted forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC) at 12 months post-transplant &lt;80% predicted based on recipient demographics, or FEV1/FVC &lt;0.7. A modified Spiro12M definition was separately analyzed whereby recipients met at least 2 criteria. Cox regression models assessed the primary endpoints of time to probable CLAD, probable CLAD composite (including CLAD-related death/retransplantation), obstructive CLAD, or graft loss (death/retransplantation).</div></div><div><h3>Results</h3><div>517 patients met inclusion criteria, with 229 (60.4%) BLTx and 109 (79.0%) SLTx recipients having abnormal Spiro12M. Among BLTx, abnormal Spiro12M was associated with an increased risk of probable CLAD composite (HR, 1.58; 95% CI, 1.09, 2.29; <em>p</em> = 0.015), while modified Spiro12M was associated with probable CLAD (HR, 1.70; 95% CI, 1.15, 2.52; <em>p</em> = 0.008), probable CLAD composite (HR, 1.82; 95% CI, 1.25, 2.65; <em>p</em> = 0.002), and graft loss (HR, 1.68; 95% CI, 1.14, 2.48; <em>p</em> = 0.009).</div></div><div><h3>Conclusions</h3><div>Spiro12M and modified Spiro12M are reproducible, clinically relevant definitions that can prospectively identify BLTx at risk for CLAD.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100473"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to let go of the biopsy? A new era in cardiac rejection monitoring?","authors":"H. Eiskjaer MD, DMSc,&nbsp;M.J. Andersen MD, PhD,&nbsp;T.S. Clemmensen MD, PhD, DMSc","doi":"10.1016/j.jhlto.2025.100478","DOIUrl":"10.1016/j.jhlto.2025.100478","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100478"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}