JHLT Open最新文献

{"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":"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":"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}

{"title":"Lung transplantation from donation after circulatory death donors over 55 years old: A national analysis of outcomes and utilization","authors":"Isaac S. Alderete MD MHS ,&nbsp;Samantha E. Halpern MD MHS ,&nbsp;Oliver K. Jawitz MD MHS ,&nbsp;Ahmed Gurses MD ,&nbsp;Haoran Jiang ,&nbsp;Hiroshi Date MD ,&nbsp;Jacob Klapper MD MHS ,&nbsp;Matthew G. Hartwig MD MHS ,&nbsp;Kunal J. Patel MD PhD","doi":"10.1016/j.jhlto.2025.100423","DOIUrl":"10.1016/j.jhlto.2025.100423","url":null,"abstract":"<div><h3>Background</h3><div>Lungs from older donation after circulatory death (DCD) donors are underutilized; however, these organs may represent an opportunity to expand the donor pool. Herein, we evaluated utilization and outcomes of lung transplants using lungs from older DCD donors.</div></div><div><h3>Methods</h3><div>Using national data from 2016 to 2024, we identified all adult DCD donors and corresponding isolated lung transplant recipients. Multivariable logistic regression was used to identify predictors of lung utilization. Kaplan-Meier and Cox proportional hazards methods were used to compare graft survival between recipients of lungs from DCD donors &lt;55 and ≥55 years.</div></div><div><h3>Results</h3><div>Among 10,769 older (age ≥ 55) DCD donors identified, lungs were transplanted from only 302 (2.8%) with significant organ procurement organization- and center-level variation in use. Just one center exceeded 50 transplants using older DCD donors over the study period. Utilization increased over time (7 cases in 2016 vs 111 in 2024; <em>p</em> &lt; 0.001). Ex-vivo lung perfusion (odds ratio 5.93) and higher PaO₂/FiO₂ ratio (odds ratio 1.33 per 50-point increase) were independently associated with transplantation of older DCD donor lungs. One- and three-year graft survival were similar between age groups; older donor age was not associated with increased risk of graft failure in adjusted models.</div></div><div><h3>Conclusions</h3><div>Lungs from older DCD donors remain underutilized despite comparable outcomes. Their use is highly concentrated among a small number of centers and organ procurement organizations, suggesting that local behaviors and infrastructure strongly influence disposition. Broader adoption of ex-vivo lung perfusion and strategic recipient matching may support safe expansion of this untapped donor pool.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571803","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":"Lung transplantation for chronic thromboembolic pulmonary hypertension","authors":"Laurent Godinas ,&nbsp;Michaela Orlitová ,&nbsp;Emanuele Muscogiuri ,&nbsp;Laurens J. Ceulemans ,&nbsp;Elie Fadel ,&nbsp;Marion Delcroix ,&nbsp;Tom Verbelen","doi":"10.1016/j.jhlto.2025.100461","DOIUrl":"10.1016/j.jhlto.2025.100461","url":null,"abstract":"<div><div>Therapeutic advances in chronic thromboembolic pulmonary hypertension (CTEPH) over the last 10 years have improved patient prognosis. As a result, the role of lung transplantation (LTx) for this indication has been greatly reduced. In this review article, we describe the evolution of treatments for CTEPH, the place that remains for lung transplantation, and the particularities of lung transplantation for this indication.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100461"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839581","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":"Bronchial stenosis after lung transplant: Risk factors and clinical outcomes","authors":"Antonio Coppolino ,&nbsp;Rie Maurer ,&nbsp;Ella Woehl ,&nbsp;Erin M. Connolly ,&nbsp;Elene Chamberlin ,&nbsp;Hilary J. Goldberg ,&nbsp;Selvin S. Jacob ,&nbsp;Stefi F. Lee ,&nbsp;John C. Kennedy ,&nbsp;Adil Sheikh ,&nbsp;Audra J. O’Neill ,&nbsp;Simran Gupta ,&nbsp;Ruben A. Hernandez Acosta ,&nbsp;Victor Kovac ,&nbsp;Mohamed Keshk ,&nbsp;Amy Hackmann ,&nbsp;John Dunning ,&nbsp;Nirmal S. Sharma ,&nbsp;Lindsey R. Baden ,&nbsp;Ann E. Woolley","doi":"10.1016/j.jhlto.2025.100392","DOIUrl":"10.1016/j.jhlto.2025.100392","url":null,"abstract":"<div><h3>Background</h3><div>Bronchial stenosis is a known complication after lung transplantation, but risk factors remain incompletely understood. We identified predictors of bronchial stenosis requiring bronchoscopic intervention, with a focus on post-transplant bacterial infections, and its impact on clinical outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 342 adult lung transplant recipients at a single center between 2017 and 2023. Bronchial stenosis was defined as localized airway narrowing requiring intervention. Clinical, perioperative, and infectious variables—censored to precede the onset of stenosis—were analyzed using univariate and multivariable logistic regression. Outcomes included survival, acute cellular and antibody-mediated rejection, and chronic lung allograft dysfunction (CLAD).</div></div><div><h3>Results</h3><div>Thirty-four patients (9.9%) developed bronchial stenosis requiring intervention. Multivariable analysis identified male sex (OR: 2.77, 95% CI: 1.13–6.79, <em>p</em> = 0.0261), pulmonary graft dysfunction (PGD) (OR: 3.45, 95% CI: 1.23–9.69, <em>p</em> = 0.0190), length of index hospitalization (OR: 1.01, 95% CI: 1.00–1.02, <em>p</em> = 0.0479), and any positive post-transplant bacterial respiratory culture—prior to onset of stenosis—(OR: 3.97, 95% CI: 1.67–9.48, <em>p</em> = 0.0019) as independent risk factors. Pneumonia and colonization with <em>Pseudomonas aeruginosa</em> or other gram-negatives were strongly associated with stenosis, while <em>Staphylococcus aureus</em> infections and colonization were not. Bronchial stenosis did not significantly impact survival, rejection, or CLAD incidence.</div></div><div><h3>Conclusions</h3><div>Bronchial stenosis following lung transplantation is associated with PGD and bacterial airway infections, particularly <em>Pseudomonas</em> species or other gram negatives. These findings support an association between early gram-negative bacterial airway infections and bronchial stenosis and highlight the need for infection prevention and further prospective studies to clarify causal mechanisms and guide targeted interventions.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100392"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026122","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":"The unsung heroes: A scoping review of the experiences of lung transplant informal caregivers","authors":"Jane Simanovski PhD, NP ,&nbsp;Jody Ralph PhD, RN ,&nbsp;Jamie Crawley PhD, RN ,&nbsp;Kelly Bryce PhD ,&nbsp;Dana Sleiman BScN, RN ,&nbsp;Edward Cruz PhD, RN","doi":"10.1016/j.jhlto.2025.100472","DOIUrl":"10.1016/j.jhlto.2025.100472","url":null,"abstract":"<div><div>Informal caregivers support patients after lung transplantation (LTx). With growing recognition of the multiple demands placed on caregivers, this scoping review aimed to systematically map the literature surrounding informal caregiving experiences after LTx using JBI guidelines. Multiple databases were searched from January 2010 to May 2025 based on a combination of synonyms and controlled vocabulary related to “caregiver” and “lung transplant recipients”. A total of 404 records were screened after the removal of duplicates. Among these, 16 sources met the inclusion criteria with 12 (75%) classified as full publications, 3 (19%) peer-reviewed conference abstracts, and 1 poster presentation. Most studies were based in North America (11/16 [69%]) with the remainder from Europe or Australia. Only 19% (3/16) of the sources were published within the past 5 years. There were 7 qualitative studies (44%), 6 quantitative (38%), 2 mixed methods (12%), and 1 literature review. Informal caregivers described a wide variety of challenges ranging from high levels of caregiver burden, psychological and emotional impacts, handling multiple daily practicalities, knowledge deficits, and the need for more support. Positive experiences of the informal caregiver role include positive adjustment, presence of support networks and relationships, improved quality of life, and benefiting from educational support and preparation. Informal caregivers remain an integral resource in supporting patients after LTx. However, most available evidence predates recent advances in transplantation practice—with 80% published before 2020—limiting its current relevance and highlighting the need for further research and targeted interventions to support this population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100472"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975964","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":"Right ventricular function assessment by transesophageal echocardiography in lung transplantation: Preoperative, intraoperative, and postoperative considerations","authors":"Etienne Revelly ,&nbsp;André Denault ,&nbsp;Alex Moore","doi":"10.1016/j.jhlto.2025.100412","DOIUrl":"10.1016/j.jhlto.2025.100412","url":null,"abstract":"<div><h3>Background</h3><div>Right ventricular (RV) function is a key determinant of outcomes in lung transplantation, particularly in patients with pre-existing pulmonary hypertension. The RV is uniquely sensitive to perioperative hemodynamic stressors, including ischemia-reperfusion injury, abrupt afterload changes, and allograft implantation.</div></div><div><h3>Purpose</h3><div>This review aims to summarize the perioperative echocardiographic assessment of RV function in lung transplantation, emphasizing the role of transesophageal echocardiography (TEE) in evaluating RV performance and guiding intraoperative management.</div></div><div><h3>Methods</h3><div>A comprehensive synthesis of recent literature was performed, focusing on echocardiographic parameters relevant to RV evaluation during the preoperative, intraoperative, and postoperative phases of lung transplantation. Both conventional and advanced imaging modalities were reviewed.</div></div><div><h3>Discussion</h3><div>TEE provides real-time insights into RV adaptation and dysfunction. Key parameters include fractional area change, tricuspid annular plane systolic excursion (TAPSE), tricuspid annular velocity (S’), and speckle-tracking–derived strain. Three-dimensional echocardiography enhances volumetric and geometric assessment, while venous congestion indices such as the Venous Excess Ultrasound (VExUS) score offer indirect hemodynamic evaluation. Intraoperatively, dynamic monitoring supports optimization of preload, afterload, and inotrope therapy. Postoperative complications—such as RV outflow tract obstruction and pulmonary vascular anastomotic dysfunction—require prompt recognition. Persistent RV dysfunction despite afterload reduction may reflect intrinsic myocardial disease.</div></div><div><h3>Conclusion</h3><div>Comprehensive echocardiographic evaluation throughout all perioperative phases is essential for optimizing RV performance and improving outcomes in lung transplantation. Future studies should aim to standardize RV assessment protocols and validate multimodal imaging approaches for perioperative clinical decision-making.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100412"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145469028","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}