JHLT Open最新文献

{"title":"Incidence, prevalence, and predictors of osteoporotic fracture in adult lung transplant recipients","authors":"Elisabeth Ng ,&nbsp;Shanal Kumar ,&nbsp;Eldho Paul ,&nbsp;Daniel Bennett ,&nbsp;Luisa Rosi ,&nbsp;Louise Fuller ,&nbsp;Lauren Chiu ,&nbsp;Shoshana Sztal-Mazer ,&nbsp;Steven Ivulich ,&nbsp;Greg Snell ,&nbsp;Leon A. Bach ,&nbsp;Kathryn L. Hackman","doi":"10.1016/j.jhlto.2024.100182","DOIUrl":"10.1016/j.jhlto.2024.100182","url":null,"abstract":"<div><h3>Background</h3><div>As life expectancy following lung transplantation (LT) improves, vulnerability to glucocorticoid-induced osteoporotic fractures is increased. Our institution offers LT recipients protocolized antiresorptive therapy, with zoledronic acid (ZA) used first line.</div></div><div><h3>Methods</h3><div>Adults who underwent LT from January 2012 to December 2018 and survived at least 6 months were retrospectively studied. Coprimary outcomes were incidence, prevalence, and predictors of osteoporotic fractures and major osteoporotic fractures post-LT.</div></div><div><h3>Results</h3><div>Four hundred and five LT recipients (41% female, median age 59 years) had a median follow-up of 4.9 years (interquartile range 3.4-6.7). Osteoporotic fracture prevalence was 12% (<em>n</em> = 49) pre-LT and 15% (<em>n</em> = 60) post-LT. Major osteoporotic fracture post-LT occurred in 11% (<em>n</em> = 45). Antiresorptive therapy was received by 47% pre- and 89% post-LT. On multivariate analysis, risk factors for osteoporotic fracture were pre-LT osteoporotic fracture (hazard ratio (HR) 2.32 (95% confidence interval (CI) 1.09-4.96)), female sex (HR 2.08 (95% CI 1.09-3.94)), glucocorticoid use pre-LT (HR 2.08 (95% CI 1.09-3.99)), and time (months) to first ZA infusion post-LT (HR 1.04 (95% CI 1.01-1.06)). Risk factors for major osteoporotic fracture were pre-LT osteoporotic fracture, female sex, age, and time to first ZA infusion.</div></div><div><h3>Conclusion</h3><div>LT recipients receiving protocolized antiresorptive treatment post-LT had a low incidence of osteoporotic fracture.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100182"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of Thoracic Aortic Aneurysm repair post Heart Transplantation","authors":"Helena Garcia Betinardi Bernardi ,&nbsp;Cristhian Espinoza Romero ,&nbsp;Vanessa Simioni Faria ,&nbsp;Fabiana G. Marcondes-Braga ,&nbsp;Fabio A. Gaiotto ,&nbsp;Fernando Bacal","doi":"10.1016/j.jhlto.2024.100183","DOIUrl":"10.1016/j.jhlto.2024.100183","url":null,"abstract":"<div><div>During bicaval orthotopic heart transplant (HT), two segments of the aorta are generated, separated by a suture line. Both segments are exposed to the same systemic environment. Nevertheless, it has been observed that aneurysmal disease is confined to one of the segments of aorta. We report here a successful repair of AA, confined to the donor portion of aorta, in a HT recipient after 12 years of transplant.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series","authors":"Anh Nguyen MD, PhD ,&nbsp;Rima Bouajram PharmD ,&nbsp;Marek Brzezinski MD ,&nbsp;Sahand Hassanipour ,&nbsp;David Gordon ,&nbsp;Binh Trinh MD ,&nbsp;Tobias Deuse MD ,&nbsp;Aida Venado MD ,&nbsp;Steve Hays MD ,&nbsp;Jonathan Singer MD ,&nbsp;Jasleen Kukreja MD, MPH","doi":"10.1016/j.jhlto.2024.100189","DOIUrl":"10.1016/j.jhlto.2024.100189","url":null,"abstract":"<div><h3>Background</h3><div>The use of hydroxocobalamin following lung transplantation has not been previously reported. We present a series of 3 cases where hydroxocobalamin was used to treat postoperative vasoplegia.</div></div><div><h3>Methods</h3><div>We conducted a single-center, retrospective review of lung transplantation recipients from January 2016 to December 2020. We used cumulative vasopressor index to standardize vasopressor dose administered and mean arterial pressure at 2- and 24-hour time-points following hydroxocobalamin administration to assess treatment effectiveness.</div></div><div><h3>Results</h3><div>We identified 3 male patients aged 49 to 62, with lung allocation scores between 89.9 and 90.6, requiring extracorporeal membrane oxygenation support (pre- and post-transplant for 5, 5, 9 and 8, 2, 2 days, respectively). Each patient received hydroxocobalamin 5,000 mg infused over 15 minutes, with patient #3 receiving an additional 6 doses over the subsequent 4 days. At the 2-hour time-point, mean arterial pressure increased in all patients (+11%, +17%, and +13%, respectively), although cumulative vasopressor indexes were inconsistent. At 24 hours, patients #1 and #2 demonstrated a marked increase in mean arterial pressure (36% and 23%, respectively) and a decrease in cumulative vasopressor index, while patient #3 displayed stable with slight reduction in cumulative vasopressor index and mean arterial pressure values. No allergic reactions were observed. Patient #3 developed methemoglobinemia and a medication-related false increase in triglycerides. All 3 patients were discharged home.</div></div><div><h3>Conclusions</h3><div>Hydroxocobalamin may be a valuable adjunct in managing refractory vasoplegia following lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100189"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Development of a hub-and-spoke durable left ventricular assist device program in Brazil, a middle-income country” [JHLT Open, 6 (2024) 100151]","authors":"Deborah de Sá Pereira Belfort ,&nbsp;Bruno Biselli ,&nbsp;Mônica Samuel Avila ,&nbsp;Renata Lopes Hames ,&nbsp;Stephanie Itala Rizk ,&nbsp;Fabrício Canova Calil ,&nbsp;Bruna Carneiro Oliveira ,&nbsp;Elaine Marques Hojaij ,&nbsp;Filomena Regina Barbosa Gomes Galas ,&nbsp;Ludhmila Abrahão Hajjar ,&nbsp;Nadine Oliveira Clausell ,&nbsp;Livia Adams Goldraich ,&nbsp;Ramez Anbar ,&nbsp;Edimar Alcides Bocchi ,&nbsp;Tadeu Thomé ,&nbsp;Roberto Kalil Filho ,&nbsp;Paulo Manuel Pêgo-Fernandes ,&nbsp;Fabio Biscegli Jatene ,&nbsp;Silvia Moreira Ayub-Ferreira","doi":"10.1016/j.jhlto.2024.100193","DOIUrl":"10.1016/j.jhlto.2024.100193","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143171928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Derivation of a simple risk calculator for predicting clinical worsening in patients with pulmonary hypertension due to interstitial lung disease","authors":"K. El-Kersh ,&nbsp;R. Bag ,&nbsp;N. Bhatt ,&nbsp;C. King ,&nbsp;A. Waxman ,&nbsp;F. Rischard ,&nbsp;H. Kim ,&nbsp;D. Cella ,&nbsp;E. Shen ,&nbsp;SD Nathan","doi":"10.1016/j.jhlto.2025.100206","DOIUrl":"10.1016/j.jhlto.2025.100206","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension due to interstitial lung disease (ILD-PH) portends very poor clinical outcomes, with a median survival time of 1.5 to 2 years. Currently, there is no tool to assess the risk of clinical worsening in patients with ILD-PH. Our aim was to derive a simple and practical risk calculator that could be used to predict risk of clinical worsening in patients with ILD-PH.</div></div><div><h3>Methods</h3><div>The INCREASE study was a 16-week study that evaluated inhaled treprostinil in patients with ILD-PH. Baseline data from patients who were randomized to the placebo arm (n=163) and thus untreated with any approved pulmonary artery vasodilators were used to derive a risk calculator. The endpoint of interest was the time to clinical worsening. Stepwise regression, Harrell’s c-index, and clinician input were used to derive 2 multivariable Cox PH models from a set of candidate variables. The models were then simplified by applying a point-scoring system to the predictors and refitting with total point score as the covariate. Total point scores were grouped into 3 risk strata (lower, intermediate, and higher).</div></div><div><h3>Results</h3><div>Two versions of a risk calculator were derived. The first was a non-invasive risk calculator which included NT-proBNP and FVC%/DLCO%, and a second adds cardiac index, an invasive parameter, to the above two parameters. For the total point score models, the estimated c-indices were 0.703 (95% CI: 0.635, 0.783) and 0.683 (95% CI: 0.612, 0.761) for the invasive and non-invasive model, respectively.</div></div><div><h3>Conclusion</h3><div>These two risk calculators provide a simple way to risk stratify ILD-PH patients with clinically useful discrimination. The calculators are easy to employ in clinical practice, since they utilize assessments commonly collected in the care of patients with ILD-PH. Moreover, the calculators can provide clinicians with important prognostic information which can be used to reinforce the benefits of therapy. The risk calculators may also find utility as part of the composite allocation score of ILD-PH patients listed for lung transplant. Future research in this area could include incorporating longer-term outcomes as well as validating the risk models in a separate patient population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implant","authors":"Ibrahim Mortada MD ,&nbsp;Christos Kourek MD, PhD ,&nbsp;Rupesh Kshetri MD ,&nbsp;Arun Singhal MD ,&nbsp;Anthony Panos MD ,&nbsp;Alexandros Briasoulis MD, PhD ,&nbsp;Mohammed Mhanna MD, MPH ,&nbsp;Shareef Mansour MD ,&nbsp;Kristine Yumul MD ,&nbsp;Paulino Alvarez MD ,&nbsp;Ernesto Ruiz Duque MD","doi":"10.1016/j.jhlto.2024.100195","DOIUrl":"10.1016/j.jhlto.2024.100195","url":null,"abstract":"<div><h3>Background</h3><div>The use of continuous flow left ventricular assist device (CF-LVAD) has revolutionized the management of advanced heart failure. One of the major complications associated with its use is the risk of bleeding, especially in the early postoperative period. Early events of postoperative bleeding have been associated with higher morbidity and mortality rates. Our study aims at identifying potential predictors of intraoperative bleeding, defined as 4 or more units of packed red blood cells transfused during surgery. A single-center retrospective cohort study of adult patients older than 18 years old who underwent CF-LVAD implantation between 2009 and 2024.</div></div><div><h3>Methods</h3><div>Data were collected for the duration of implant hospitalization, including perioperative invasive hemodynamics, echocardiography, operative details, mechanical circulatory support, antiplatelets, inotropes, bleeding events, and blood product use, in addition to patient history and baseline characteristics.</div></div><div><h3>Results</h3><div>A total of 208 patients were included in the analysis. Intraoperative bleeding occurred in 43 (20.67%) patients while 165 (79.33%) patients did not experience bleeding. Multilogistic regression analysis showed that artery bypass grafting pre-LVAD (odds ratio [OR] 2.98, confidence interval [CI] 1.2-7.42, <em>p</em> = 0.01) and temporary mechanical assist device pre-LVAD (OR 3.67, 95%CI 1.72-7.85, <em>p</em> &lt; 0.001) were independent predictors of intraoperative bleeding during hospitalization. Intraoperative bleeding is also correlated with worse clinical outcomes, higher 90-day mortality (hazard ratio [HR] 10.4, <em>p</em> &lt; 0.01, CI 95% 3.28-33.38) 206 subjects with 14 failures.</div></div><div><h3>Conclusion</h3><div>History of coronary artery bypass grafting and mechanical circulatory support before the implantation of LVAD are independent predictors of intraoperative bleeding during hospitalization in these patients. Intraoperative bleeding is associated with higher frequency of right ventricle failure post-LVAD and higher 90-day mortality.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ex vivo delivery of recombinant IL-10 to human donor lungs","authors":"Jonathan C. Yeung,&nbsp;Terumoto Koike,&nbsp;Dirk Wagnetz,&nbsp;Tiago N. Machuca,&nbsp;Riccardo Bonato,&nbsp;Mingyao Liu,&nbsp;Stephen Juvet,&nbsp;Marcelo Cypel,&nbsp;Shaf Keshavjee","doi":"10.1016/j.jhlto.2024.100192","DOIUrl":"10.1016/j.jhlto.2024.100192","url":null,"abstract":"<div><h3>Background</h3><div>The immunoregulatory cytokine interleukin-10 (IL-10) has been shown to be a promising therapy for donor lung injuries before transplantation. However, the very short half-life of IL-10 in vivo (∼2 hours) has necessitated the use of gene therapy in almost all animal models of lung transplantation. Because isolation of the donor lung on the ex vivo lung perfusion (EVLP) circuit removes it from the influence of renal and hepatic clearance mechanisms, a much-prolonged half-life of IL-10 is anticipated. Thus, we hypothesized that delivery of recombinant IL-10 (rIL-10) to injured donor lungs isolated on EVLP could be a clinically relevant and a logistically simpler method of employing IL-10 therapy in lung transplantation.</div></div><div><h3>Methods</h3><div>Injured human donor lungs clinically rejected for transplantation were split into single lungs and the better of the 2 subjected to 12 hours of EVLP and randomized (<em>n</em> = 5/group) to receive either saline (control), rIL-10 (5 µg in 2-liter perfusate), or rIL-10 (25 µg) aerosolized into the airways.</div></div><div><h3>Results</h3><div>Perfusate and intratracheal delivery of rIL-10 did not provide the therapeutic anti-inflammatory action that has been traditionally achieved with gene therapy. It appears that intratracheally delivered rIL-10 moves into the perfusate where it seems to be biologically inactive.</div></div><div><h3>Conclusions</h3><div>Gene therapy remains superior as it allows for continued production of IL-10 within the alveoli where it has the potential to continuously act on alveolar macrophages and epithelial cells in a paracrine fashion.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it safe to proceed with heart transplant in a patient with active tuberculosis? Strategies and challenges based on a case report","authors":"Laura Hastenteufel ,&nbsp;Marcelo Basso Gazzana ,&nbsp;Nadine Clausell ,&nbsp;Lívia Adams Goldraich MD","doi":"10.1016/j.jhlto.2024.100188","DOIUrl":"10.1016/j.jhlto.2024.100188","url":null,"abstract":"<div><div>Transplant candidates are at increased risk of developing active tuberculosis (TB), and its diagnosis and treatment may be especially challenging. Although screening and treatment for TB are recommended in heart transplant candidates, there is lack of evidence on how to manage active TB infection in this scenario. Herein, we report challenges of performing a heart transplant in a 69-year-old patient with progressive heart failure and active, symptomatic TB infection. We aimed to emphasize the importance of proper screening of TB in solid organ transplant candidates, as well as to suggest that, in selected patients, it may be safe to proceed with transplant after an initial period of treatment with antituberculous agents.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Candida dubliniensis breast implant infection in a lung transplant recipient","authors":"Ashley Barnes MD ,&nbsp;Kristen Broderick MD ,&nbsp;Errol Bush MD ,&nbsp;Jonathan Orens MD ,&nbsp;Melanie Marashly CRNP ,&nbsp;Shmuel Shoham MD ,&nbsp;Robin Avery MD","doi":"10.1016/j.jhlto.2024.100194","DOIUrl":"10.1016/j.jhlto.2024.100194","url":null,"abstract":"<div><div>This report details the case of a lung transplant recipient with a remote history of breast cancer and breast reconstruction with implants, who received lengthy antifungal therapy for a post-transplant donor-transmitted <em>Candida dubliniensis</em> empyema. Despite this, she presented months later with a progressive infection of bilateral breast implants, which also proved to be due to <em>Candida dubliniensis</em>. Few cases of breast implant infection after lung transplant have been published. It is possible that biofilm created a barrier to penetration of antifungals, which were able to suppress but not eradicate infection. This case highlights the importance of deep operative cultures for diagnosis and management of infections of this type.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undocumented immigrants and advanced heart failure therapies","authors":"Matthew Kogan ,&nbsp;Sarah L. Kimball ,&nbsp;Katherine Purrington ,&nbsp;Jennifer Cedor ,&nbsp;Omar K. Siddiqi MD","doi":"10.1016/j.jhlto.2025.100207","DOIUrl":"10.1016/j.jhlto.2025.100207","url":null,"abstract":"<div><div>This study highlights the challenges undocumented immigrants face in accessing advanced heart failure therapies, despite contributing to the organ donor pool. Some key barriers are the lack of provider awareness, social support issues, and timing constraints. The survey conducted among cardiologists at Massachusetts teaching hospitals revealed that while most providers (82.5%) refer patients with undocumented status for advanced therapies, a significant percentage (87.5%) that still perceive immigration status as a barrier to transplantation. Addressing these misconceptions through legal partnerships and enhancing provider education is crucial for improving access to life-saving treatments for undocumented patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100207"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143171927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}