JHLT Open最新文献

{"title":"Outcomes and management strategies of pregnancies after heart and lung transplantation across Europe","authors":"Jildau R. Meinderts ,&nbsp;Linda W. van Laake ,&nbsp;Dieuwertje Ruigrok ,&nbsp;Olivier Manintveld ,&nbsp;Jérôme Le Pavec ,&nbsp;Michael Perch ,&nbsp;Jens Gottlieb ,&nbsp;Adelheid Görler ,&nbsp;Robin Vos ,&nbsp;Jesper M. Magnusson ,&nbsp;Claire Merveilleux du Vignaux ,&nbsp;Aniko Bohács ,&nbsp;Balazs Sax ,&nbsp;Tanel Laisaar ,&nbsp;Vincent Bunel ,&nbsp;Margriet E. Gosselink ,&nbsp;Merel E. Hellemons ,&nbsp;Kevin Damman ,&nbsp;Jelmer R. Prins ,&nbsp;A. Titia Lely ,&nbsp;Margriet F.C. de Jong","doi":"10.1016/j.jhlto.2026.100481","DOIUrl":"10.1016/j.jhlto.2026.100481","url":null,"abstract":"<div><h3>Background</h3><div>Literature on pregnancy after heart and/or lung transplantation (heart transplantation (HTx), lung transplantation (LTx), heart lung transplantation (HLTx)) remains sparse. This study assessed short- and long-term outcomes of pregnancies post-thoracic organ transplantation across Europe and analyzed center management of these patients.</div></div><div><h3>Methods</h3><div>European centers provided retrospective data on post-HTx/LTx pregnancies and center strategies for handling transplant recipients with a pregnancy wish. Descriptive statistics and linear regression analysis were used.</div></div><div><h3>Results</h3><div>Forty-two females had 50 pregnancies across 12 European centers. Pregnancy-induced hypertension occurred in 50% (HTx), 28% (LTx), and 20% (HLTx), and preeclampsia in 19%, 16%, and 20%, respectively. Preterm birth (&lt;37 weeks) occurred in 23% (HTx) and 68% (LTx), and birth weight &lt;2,500 g in 8% and 58%, respectively. Live birth rate was 98%. In multivariable analysis, a trend for higher birth weight with higher pre-pregnancy estimated glomerular filtration rate was observed (B 13.3, 95% CI −1.7-28.4, <em>p</em> = 0.08). Graft function remained stable in most patients during and after pregnancy. During follow-up (mean 15 years, range 5-31 post-transplantation), 6/40 mothers (15%) died (1 HTx, 2 LTx, 3 HLTx), with their children aged 0-11 years. No specific physical health problems were mentioned in 29/30 children (age 0-22 years). Physician opinions towards pregnancy differed from reluctant (31%) to positive (69%), with numerous management variations.</div></div><div><h3>Conclusions</h3><div>We show reassuring pregnancy outcomes for post-HTx, LTx, and HLTx patients in an exclusive European cohort, despite high pregnancy complication rates. Graft function and overall maternal survival appear unaffected. We highlight differences in pregnancy management between centers and suggest development of a uniform approach.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100481"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077309","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":"Three-year outcomes with the use of dual non-invasive rejection surveillance after heart transplantation","authors":"Erik J. Henricksen PharmD ,&nbsp;Juka S. Kim MD ,&nbsp;Kiran K. Khush MD, MAS ,&nbsp;Joyce Njoroge ,&nbsp;Helen Luikart RN, MSN ,&nbsp;Melody B. Zhang MD ,&nbsp;Roy Lee PharmD ,&nbsp;Thu Le PharmD ,&nbsp;Brandon A. Guenthart MD ,&nbsp;Jeffrey J. Teuteberg MD","doi":"10.1016/j.jhlto.2025.100456","DOIUrl":"10.1016/j.jhlto.2025.100456","url":null,"abstract":"<div><h3>Background</h3><div>Donor-derived cell-free DNA (ddcfDNA) and gene expression profiling (GEP) allow for non-invasive monitoring of rejection after heart transplantation in place of endomyocardial biopsies (EMBx). However, data are limited on the impact this strategy has on heart transplant graft outcomes after 2 years post transplant.</div></div><div><h3>Methods</h3><div>This is a single center, retrospective analysis of adult heart transplant recipients, comparing a rejection surveillance cohort of GEP/biopsy (1/2015–12/2017) against a rejection surveillance cohort of GEP/ddcfDNA (7/2018–12/2020). The primary outcome was survival at 3 years post transplant. Secondary outcomes included ejection fraction (EF), rejection free survival, total number of EMBx in follow-up period, and development of de novo donor specific antibodies (dnDSA).</div></div><div><h3>Results</h3><div>A total of 88 patients in the GEP/Biopsy cohort and 90 patients in the GEP/ddcfDNA cohort were included in the analysis. When comparing GEP/Biopsy against GEP/ddcfDNA, overall survival (85.2% vs. 86.7%, p=0.78). Biopsy proven acute cellular rejection (70.5% vs 83.3%, p = 0.062), biopsy proven antibody mediated rejection (97.7 vs. 94.5%, p = 0.26), LVEF at 3 years [60.3 (57.9–63.6) vs. 60.3 (57.5–63.1], and development of dnDSA [34/88 (38.6%) vs. 36/91 (39.6%), p = 1.0] when comparing GEP/biopsy against GEP/ddcfDNA, indicating similar clinical outcomes. However, patients in the GEP/ddcfDNA had fewer biopsies [4 (3−6) vs. 12 (10−14), p&lt;0.001)].</div></div><div><h3>Conclusions</h3><div>When comparing a rejection surveillance strategy of GEP/biopsy against GEP/ddcfDNA, heart transplant outcomes were similar at 3 years, while a strategy of GEP/ddcfDNA resulted in significantly fewer EMBx.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100456"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839580","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":"Correlation between acute cellular rejection detected with cryobiopsy and elevated donor-derived cell-free DNA in lung transplant recipients","authors":"Carolin Steinack MD ,&nbsp;Macé M. Schuurmans ,&nbsp;Silvan M. Vesenbeckh ,&nbsp;René Hage ,&nbsp;Zsofia Rosselli ,&nbsp;Silvia Ulrich ,&nbsp;Malcolm Kohler ,&nbsp;Jan Rüschoff ,&nbsp;Martina Haberecker ,&nbsp;Maurice Roeder ,&nbsp;Thomas Gaisl","doi":"10.1016/j.jhlto.2025.100463","DOIUrl":"10.1016/j.jhlto.2025.100463","url":null,"abstract":"<div><h3>Introduction</h3><div>Donor-derived cell-free DNA (dd-cfDNA) may be a promising biomarker for detecting acute cellular rejection (ACR) in lung transplant recipients (LTR) without the need for invasive transbronchial biopsies. We aimed to validate a clinical plasma dd-cfDNA assay for the detection of ACR, as determined by cryobiopsy, and to assess its clinical utility.</div></div><div><h3>Methods</h3><div>In this prospective cohort, dd-cfDNA fraction was measured using a novel single-nucleotide polymorphism-based assay in LTR undergoing surveillance bronchoscopy with cryobiopsies 2, 4, 6, and 12 months after transplantation (and when indicated). Performance characteristics were calculated for LTR without ACR and LTR with ACR (defined as ACR based on pathological assessment of the cryobiopsies ≥A1).</div></div><div><h3>Results</h3><div>The incidence of ACR (A1 (<em>N</em> = 2), grade A2 (<em>N</em> = 3), grade A3 (<em>N</em> = 1), and no grade A4 or antibody-mediated rejection) was 14% in 43 samples of 39 LTR. The median dd-cfDNA fraction was similar for the stable cohort and the cohort with ACR (median 0.41% [0.15% to 0.72%] vs 0.56% [0.10% to 3.07%], <em>p</em> = 0.630). The area under the receiver operator characteristic curve for ACR was 59.3% (95% CI 38.3%−80.3%). Using a ≥1% dd-cfDNA fraction threshold (≥0.5% for single lung transplantations), the negative predictive value for ACR was 87.9% (95% CI 74.1%-97.6%), and the positive predictive value was 20.0% (95% CI 8.0%-32.0%). In the sensitivity analysis, altering the ACR category (≥A1 vs ≥A2) or the dd-cfDNA threshold &gt;0.85% did not produce significant changes in the outcomes.</div></div><div><h3>Conclusion</h3><div>The incidence of ACR (≥A1 or ≥A2) did not appear to be closely associated with the fraction of dd-cfDNA. More research with a larger sample size and long-term follow-up is needed to evaluate the association between dd-cfDNA and ACR incidence detected by cryobiopsy.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100463"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839588","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":"Beating heart transplantation: A single center’s initial experience and propensity-matched analysis against national registry data","authors":"Ashley Y. Choi MD, MHS ,&nbsp;Ntemena Kapula MS ,&nbsp;Hao He PhD ,&nbsp;Ellelan Degife MD ,&nbsp;Aravind Krishnan MD ,&nbsp;Reza Ashrafi ,&nbsp;Bridgette Han BA ,&nbsp;Katherine Pines MPH ,&nbsp;Erik Henricksen PharmD ,&nbsp;Stefan Elde MD ,&nbsp;Moeed Fawad BS ,&nbsp;Jeffrey J. Teuteberg MD ,&nbsp;Kiran K. Khush MD, MAS ,&nbsp;Helen Luikart MSN ,&nbsp;Chawannuch Ruaengsri MD ,&nbsp;Yasuhiro Shudo MD ,&nbsp;John W. MacArthur MD ,&nbsp;William Hiesinger MD ,&nbsp;Y. Joseph Woo MD ,&nbsp;Brandon A. Guenthart MD","doi":"10.1016/j.jhlto.2025.100455","DOIUrl":"10.1016/j.jhlto.2025.100455","url":null,"abstract":"<div><h3>Objective</h3><div>Beating heart transplantation (BHT) was adopted to avoid an additional episode of cardioplegic arrest and reperfusion and reduce allograft ischemia-reperfusion injury. We sought to establish a direct comparison of outcomes between the first cohort of BHT recipients at our center and standard DCD recipients across the US.</div></div><div><h3>Methods</h3><div>The UNOS registry was queried to identify adult recipients who underwent first-time isolated DCD HT between 12/2019–12/2023 (before the first BHT was performed outside of our center). All adult patients who underwent first-time isolated DCD BHT between 10/2022–9/2024 at our center were included. Nearest neighbor propensity-score matching was performed and groups were compared for 30-day survival, need for post-transplant mechanical circulatory support, major complications, length of stay, and 1-year survival.</div></div><div><h3>Results</h3><div>A total of 1083 standard DCD recipients and 31 BHT recipients were identified. Before matching, more BHT recipients required pre-transplant IABP (29% vs 9.8%, p=0.003) and ECMO (6.5% vs 0.7%, p=0.029), had higher status on the waitlist (Status 1–3; 97.5% vs. 62%, p&lt;0.001), and spent fewer days waiting [7(5,14) vs 30(9149) days, p&lt;0.001). After matching, BHT recipients demonstrated similar 30-day survival (100% vs 98.3%, p&gt;0.9) and improved 1-year graft survival (100% vs 83.9%, p&lt;0.001) compared to standard DCD recipients.</div></div><div><h3>Conclusion</h3><div>Despite BHT recipients being sicker than standard DCD recipients pre-transplant, their matched survival at 30-days was similar and graft survival was improved at 1-year post-transplant. While BHT may confer excellent early post-transplant outcomes, a larger sample size and longer-term follow-up are needed to confirm the survival benefit associated with BHT.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100455"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789609","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":"Impact of cardiac resynchronization therapy in patients with left ventricular assist devices: A systematic review and meta-analysis","authors":"Miloud Cherbi MD ,&nbsp;Paul Gautier MD ,&nbsp;Raphael Martins MD, PhD ,&nbsp;Romain Itier MD ,&nbsp;Laurence Barde MD ,&nbsp;Philippe Maury MD, PhD ,&nbsp;Clément Delmas MD, PhD","doi":"10.1016/j.jhlto.2025.100476","DOIUrl":"10.1016/j.jhlto.2025.100476","url":null,"abstract":"<div><h3>Background</h3><div>Many patients with left ventricular assist devices (LVADs) have cardiac resynchronization therapy (CRT). However, the impact of CRT on their clinical and hemodynamic outcomes remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis to evaluate CRT's impact on survival in LVAD patients. We searched PUBMED, EMBASE, and Cochrane databases from inception through April 30, 2025, for studies reporting outcomes in LVAD patients with CRT. The primary outcome was all-cause mortality in patients with versus without CRT. Secondary clinical outcomes included ventricular arrhythmias (VAs) and shocks delivered. Hemodynamic outcomes included heart rate, right atrial pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, thermodilution cardiac output, pulmonary artery saturation, right ventricular stroke work index, and left ventricular end-diastolic diameter.</div></div><div><h3>Results</h3><div>Thirteen studies, including 3,665 patients, were analyzed. Cardiac resynchronization therapy (CRT) did not demonstrate any significant survival benefit, whether comparing CRT-D versus ICD (OR 1.12 [0.85-1.48]), CRT on versus CRT off (OR 1.48 [0.87-2.53]), CRT versus no device (OR 0.99 [0.61-1.59]), or CRT versus no device or ICD (OR 1.00 [0.16-6.31]). Similarly, none of the tested comparisons showed significant differences in VAs incidence or shock rates. Biventricular pacing demonstrated no advantage for any hemodynamic outcomes, whether compared to right ventricular pacing or intrinsic rhythm.</div></div><div><h3>Conclusion</h3><div>In this meta-analysis, CRT was not associated with overall survival benefit in LVAD recipients, nor with hemodynamic improvement. Future randomized trials may be warranted to definitively establish CRT's value in this population and refine patient selection criteria for optimal outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100476"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026156","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":"Fungal colonization and CLAD in lung transplant recipients: Implications for antifungal prophylaxis and graft survival","authors":"Zehra Dhanani ,&nbsp;Isam Albaba ,&nbsp;Fatima Anjum","doi":"10.1016/j.jhlto.2025.100420","DOIUrl":"10.1016/j.jhlto.2025.100420","url":null,"abstract":"<div><h3>Background</h3><div>Fungal colonization is common after lung transplantation, but its relationship with chronic lung allograft dysfunction (CLAD) remains uncertain.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 220 adult lung transplant recipients between 2018 and 2022 at a high-volume transplant center. Colonization was defined by positive respiratory cultures without evidence of invasive fungal infection. The primary outcome was development of bronchiolitis obliterans syndrome (BOS), the predominant phenotype of CLAD. The analytic cohort comprised consecutive recipients meeting inclusion criteria, with exclusions for multiorgan or redo transplant, insufficient follow-up data, and clinically relevant pulmonary infections during follow-up, specifically invasive fungal infection and bacterial pneumonia. Multivariable cox regression models were used to examine associations between colonization and BOS-CLAD.</div></div><div><h3>Results</h3><div>Fungal colonization occurred in 121 of 220 recipients (55%), most commonly <em>Candida</em> species (95/220, 43%), <em>Penicillium</em> species (34/220, 15%), and <em>Aspergillus</em> species (21/220, 10%). BOS-CLAD developed in 35 recipients (16%) during a median follow-up of 881 days (IQR 603–1011). The median time to BOS-CLAD was shorter in colonized versus non-colonized recipients (527 vs 682 days). In adjusted models, <em>Aspergillus</em> colonization (aHR 2.14, 95% CI 1.06–4.67) and <em>Pseudomonas</em> colonization (aHR 2.13, 95% CI 1.04–4.36) were associated with BOS-CLAD. Age was inversely associated with BOS-CLAD risk (aHR 0.94, 95% CI 0.92–0.97). No clear associations were observed with <em>Candida</em> or <em>Penicillium</em> colonization. Recipient-derived colonization was more frequent (83/121, 69%) and associated with increased BOS-CLAD risk compared with donor-derived colonization.</div></div><div><h3>Conclusions</h3><div>In this single-center cohort, fungal colonization—particularly with <em>Aspergillus</em>—was associated with earlier onset of BOS-CLAD despite universal antifungal prophylaxis; although colonization may reflect disruption of airway microbiology or heightened clinical acuity rather than a direct causal pathway. These findings underscore the importance of fungal colonization and need for prospective studies to clarify mechanisms, refine prophylaxis strategies, and evaluate targeted interventions.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100420"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571802","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":"Racial, ethnic, and sex disparities in lung transplant waitlist outcomes before and after composite allocation score implementation","authors":"Sarah Y. Park MD ,&nbsp;Ryan LaVanchy MPH ,&nbsp;Nicole M. Mott MD, MSCR ,&nbsp;Michael J. Kirsch MD, MSCR ,&nbsp;Elizabeth J. Bashian MD ,&nbsp;Jack Zakrzewski MD ,&nbsp;Michael T. Cain MD ,&nbsp;Jordan R.H. Hoffman MD, MPH ,&nbsp;Rocio Lopez MS, MPH ,&nbsp;Jesse D. Schold PhD ,&nbsp;Nicholas R. Teman MD ,&nbsp;Alice L. Gray MD ,&nbsp;Kara Calhoun MD, MPH","doi":"10.1016/j.jhlto.2025.100441","DOIUrl":"10.1016/j.jhlto.2025.100441","url":null,"abstract":"<div><h3>Introduction</h3><div>We aimed to evaluate if known racial, ethnic, and sex disparities in lung transplant waitlist outcomes with the Lung Allocation Score (LAS) persist with implementation of the Composite Allocation Score (CAS).</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of the Scientific Registry of Transplant Recipients (SRTR) database, examining waitlist outcomes of all adult patients listed for lung transplantation in the United States from January 2018 to March 2024, comparing patients listed in the LAS (1/1/2018–9/9/2022) or CAS (3/9/23–3/24/24) eras.</div></div><div><h3>Results</h3><div>Black candidates had a lower likelihood of transplantation (LAS sHR: 0.85, 95% CI: 0.79–0.91, p&lt;0.001; CAS sHR: 0.81, 0.71–0.93, p=0.002) compared to White candidates in both eras, and a greater likelihood of waitlist removal (sHR: 2.31, 1.35–3.95, p=0.003) in the CAS era. Female candidates had lower rates of transplantation compared to male candidates in both eras (LAS sHR: 0.75, 0.71–0.80, p&lt;0.001; CAS sHR: 0.88, 0.79–0.98, p=0.017). There were no significant differences in extracorporeal membrane oxygenation (ECMO) or mechanical ventilation while listed between race/ethnicity in the CAS era. Female candidates had lower odds of ECMO in both eras (LAS OR: 0.74, CI: 0.58–0.95, p=0.019; CAS OR: 0.53, 0.30–0.96, p=0.037). Black candidates had a greater hazard of waitlist removal due to “other” reasons compared to White candidates in both eras (LAS sHR: 1.75, 1.27–2.42, p&lt;0.001; CAS sHR: 2.06, 1.17–3.61, p=0.013).</div></div><div><h3>Conclusion</h3><div>Disparities in lung transplant waitlist outcomes are improved but persist in the CAS era. These disparities warrant further investigation into ways to provide more equitable access to lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100441"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684604","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":"Novel markers of myocardial recovery in patients with left ventricular assist device: A cardiopulmonary exercise test and hemodynamic analysis","authors":"Charounipha Soydara NP-C ,&nbsp;Ilya Giverts MD ,&nbsp;Catharine L. Griskowitz BS ,&nbsp;Isabela Landsteiner MD ,&nbsp;Kamila Drezek BS ,&nbsp;Alexandra Minasian MS ,&nbsp;Tara L. Logan BSN ,&nbsp;Janice Camuso BSN ,&nbsp;Alexandra E. Dempsey BSN ,&nbsp;Katherine Milley NP, MSN ,&nbsp;Asishana A. Osho MD, MPH ,&nbsp;Eriberto Michel MD ,&nbsp;Erin Coglianese MD ,&nbsp;Ioannis Mastoris MD ,&nbsp;David A. D’Alessandro MD ,&nbsp;Corrine Y. Jurgens PhD, RN, FHFSA ,&nbsp;Gregory D. Lewis MD ,&nbsp;Van-Khue Ton MD, PhD","doi":"10.1016/j.jhlto.2025.100444","DOIUrl":"10.1016/j.jhlto.2025.100444","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist device (LVAD)-associated myocardial recovery is possible. Beyond peak O₂ consumption (pVO₂), parameters obtained from cardiopulmonary exercise testing (CPET), such as post exercise oxygen uptake recovery delay (VO₂RD), ventilatory efficiency (V_E/VCO₂ slope), and pressure-flow slopes from invasive hemodynamics, may offer novel insights in recovery assessment.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of 46 LVAD recipients with CPET (2014-2024), of whom 5 had complete recovery and LVAD explant (recovered group). A subset (<em>n</em> = 23) had invasive hemodynamics during CPET. VO₂RD thresholds were defined as the time required for VO₂ to fall below 12.5%, 25%, and 50% of pVO₂ (T_12.5%, T_25%, T_50%). Pressure-flow slopes were derived by regressing pulmonary artery wedge pressure (PAWP) and mean pulmonary artery pressure (PAP) against cardiac output (CO) throughout exercise.</div></div><div><h3>Results</h3><div>Compared to nonrecovered group, recovered patients had higher left ventricular ejection fraction (47% [45-48] vs 19% [16-28], <em>p</em> = 0.001), higher pVO₂ (14.0 [13.6-20.6] vs 11.0 [9.9-12.3] ml/kg/min, <em>p</em> = 0.007), shorter VO₂RD thresholds (T_12.5%: 31.4 ± 11.7 vs 47.7 ± 19.1 s, <em>p</em> = 0.03; T_25%: 46.8 ± 7.1 vs 65.3 ± 25 s, <em>p</em> = 0.0038; T_50%: 82 ± 10.1 vs 99.6 ± 20.9 s, <em>p</em> = 0.027), lower PAWP/CO (1.1 vs 3.6 mm Hg/liter/min, <em>p</em> = 0.003) and PAP/CO (2.4 vs 4.3 mm Hg/liter/min, <em>p</em> = 0.03) slopes. V_E/VCO₂ slope components in all exercise phases were similar.</div></div><div><h3>Conclusions</h3><div>VO₂RD and pressure-flow slopes were lower in recovered patients, and could be incorporated into a prospective wean protocol assessing for complete myocardial recovery in LVAD-supported patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100444"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736372","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":"Demographic differences in complication and failure to rescue rates following lung transplantation","authors":"Boateng Kubi MD, MPH ,&nbsp;Ruby Singh MD, MPH ,&nbsp;Elsayed Elsafy BS ,&nbsp;Orit Abrahim MD, MPH ,&nbsp;Lucy Nam MD ,&nbsp;Akash Premkumar MD ,&nbsp;Stevens Bontemps BS ,&nbsp;Dane C. Paneitz MD, MPH ,&nbsp;Marlena Sabatino MD ,&nbsp;Eriberto Michel MD ,&nbsp;Asishana A. Osho MD, MPH","doi":"10.1016/j.jhlto.2025.100440","DOIUrl":"10.1016/j.jhlto.2025.100440","url":null,"abstract":"<div><h3>Background</h3><div>We evaluated the association between race/ethnicity and failure to rescue (FTR) following lung transplantation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 34,184 patients undergoing primary lung transplantation (2006–2024). Race/ethnicity was categorized as non-Hispanic White (81.3%), non-Hispanic Black (9.5%), and Hispanic (9.1%). The primary outcome was FTR. Logistic regression identified predictors of FTR, while Cox proportional hazards models assessed the association between race/ethnicity and outcomes.</div></div><div><h3>Results</h3><div>Black patients experienced the highest rates of postoperative complications (26.3%) compared to non-Hispanic White (17.9%) and Hispanic patients (19.6%) (p &lt; 0.001). Mortality rate was also highest among Black patients (6.8%) compared to White (5.0%) and Hispanic patients (4.8%) (p &lt;0.001). However, race/ethnicity was not independently associated with FTR. Risk factors for FTR included dialysis at transplant (OR 2.05, 95% CI: 1.28–3.29, p=0.003), double lung transplant (OR 1.30, 95% CI: 1.09–1.56, p=0.004), and prolonged ischemic time (OR 1.05, 95% CI: 1.02–1.08, p=0.001).</div></div><div><h3>Conclusions</h3><div>While Black patients experienced higher complication and mortality rates, race/ethnicity was not independently linked to FTR after lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100440"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684601","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":"Antimicrobial pharmacokinetics and stewardship in critically Ill adult patients receiving ECMO: Challenges, evidence, and future directions","authors":"A.L. Dzierba Pharm.D., FCCP, FCCM, FASHP ,&nbsp;Y-H. Liang ,&nbsp;H. Lyster PhD, FRPharmS, FFRPS","doi":"10.1016/j.jhlto.2025.100438","DOIUrl":"10.1016/j.jhlto.2025.100438","url":null,"abstract":"<div><div>Infection is a common indication and complication for extracorporeal membrane oxygenation (ECMO), and adult ECMO recipients face increased nosocomial infection risk. Effective antimicrobial dosing in these patients remains difficult due to pharmacokinetic (PK) and pharmacodynamic (PD) alterations driven by critical illness and extracorporeal circuits. In this narrative review we aim to discuss the potential impact of ECMO on antimicrobial PK and dosing requirements. Findings across studies show heterogeneity in dosing practices and indicate that inter-patient variability is influenced more by critical illness and organ dysfunction than ECMO alone. Standardized dosing protocols remain lacking, and in the absence of robust guidelines, current best practice involves applying PK/PD principles, using therapeutic drug monitoring, and individualizing dosing strategies. Across all antimicrobial drug classes, robust prospective studies linking PK/PD targets to clinical outcomes are lacking. Future research should focus on prospective trials correlating dosing regimens with meaningful clinical endpoints to refine evidence-based antimicrobial guidance. These efforts are essential to developing evidence-based dosing recommendations and optimizing antimicrobial stewardship in this high-risk population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684706","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}