JHLT Open最新文献

{"title":"Optimizing recovery of marginal donor hearts with low ejection fraction: A national retrospective study from Switzerland","authors":"Raphaël Giraud ,&nbsp;Selina Adam ,&nbsp;Benjamin Assouline ,&nbsp;Franziska Beyeler ,&nbsp;Roger Hullin ,&nbsp;Karim Bendjelid ,&nbsp;Franz Immer","doi":"10.1016/j.jhlto.2025.100411","DOIUrl":"10.1016/j.jhlto.2025.100411","url":null,"abstract":"<div><h3>Background</h3><div>In Switzerland, heart transplantation is limited by donor availability. Marginal donor hearts—characterized by older age, comorbidities, or reduced left ventricular ejection fraction (LVEF)—are often declined despite being structurally normal. Since impaired LVEF may be reversible, optimized donor management could improve cardiac function and transplant eligibility.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 415 brain-dead donors (2017–2021) from the Swiss Organ Allocation System. Donors were categorized as optimal (LVEF ≥50%) or marginal (LVEF 15–49%), irrespective of structural abnormalities, to focus on a modifiable functional parameter. Predictors of heart transplantation were assessed using univariate and multivariable logistic regression. Additional analyses evaluated hemodynamic monitoring, diagnostic strategies, management duration, and functional recovery based on serial echocardiography.</div></div><div><h3>Results</h3><div>Among 415 donors, 287 were optimal and 62 marginal. Transplantation rates were higher in optimal hearts (62.7% vs. 23.6%, p &lt; 0.001). LVEF ≥50% independently predicted transplantation (adjusted OR = 4.56; 95% CI: 2.34–8.89; p &lt; 0.001), together with younger age, lower norepinephrine dose, central monitoring, and repeated echocardiography. Marginal hearts demonstrated significant improvement in LVEF after optimized management (p &lt; 0.0001), suggesting that reversible dysfunction can be mitigated through tailored hemodynamic and pharmacologic strategies.</div></div><div><h3>Conclusions</h3><div>Optimized donor management can restore left ventricular function in marginal hearts and enhance transplant eligibility. Standardized national guidelines may help expand the donor pool and improve transplantation outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100411"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145469086","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 initial hematocrit levels during direct procurement and perfusion on the likelihood of primary graft dysfunction in donation after circulatory death heart transplantation","authors":"Emmanuel Odekunle BS ,&nbsp;Adham Makarem MD, MPH ,&nbsp;George Olverson BS ,&nbsp;Kamila Drezek BS ,&nbsp;Eriberto Michel MD ,&nbsp;David D’Alessandro MD ,&nbsp;Ioannis Mastoris MD ,&nbsp;Shannon N. Tessier PhD ,&nbsp;Asishana Osho MD, MPH ,&nbsp;S. Alireza. Rabi MD, PhD","doi":"10.1016/j.jhlto.2025.100442","DOIUrl":"10.1016/j.jhlto.2025.100442","url":null,"abstract":"<div><h3>Background</h3><div>Optimizing perfusion parameters when using ex vivo heart perfusion systems is critical for maximizing organ quality and extending perfusion duration. Hematocrit (HCT) of the perfusate may influence oxygen delivery and perfusion dynamics, yet its clinical significance remains uncertain.</div></div><div><h3>Methods</h3><div>In this retrospective single-center study, we utilize regression models to explore the relationship between hematocrit (HCT) of the device perfusate during normothermic machine perfusion (using the Transmedics Organ System [OCS]) and recipient outcomes following transplantation. Cohorts with HCT &lt;15% packed cell volume [PCV] were compared with those with HCT ≥15% PCV.</div></div><div><h3>Results</h3><div>Among 74 recipients, moderate and severe primary graft dysfunction (defined as needing extracorporeal machine oxygenation post-transplant) did not differ significantly between cohorts. Mean inotrope scores 48 hours post admission were significantly higher in recipients with higher perfusate HCT. The ICU length of stay in the higher HCT group was numerically high but did not achieve statistical significance.</div></div><div><h3>Conclusion</h3><div>Higher perfusate HCT was not associated with reduced PGD and may be linked to increased postoperative support requirements. These findings raise important questions about optimal HCT levels for ex vivo perfusion and warrant further prospective investigation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100442"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789608","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":"Left ventricular assist device implantation in advanced kidney disease","authors":"Benjamin N. French MD ,&nbsp;Anudeep S. Nakirikanti MD ,&nbsp;Ian Kusher BS ,&nbsp;Kris Wittersheim RN, MSN, APRN-BC ,&nbsp;J. David Vega MD ,&nbsp;Mani Daneshmand MD ,&nbsp;Divya Gupta MD","doi":"10.1016/j.jhlto.2025.100422","DOIUrl":"10.1016/j.jhlto.2025.100422","url":null,"abstract":"<div><h3>Background</h3><div>Advanced chronic kidney disease (CKD) is often considered a contraindication to left ventricular assist device (LVAD) implantation, yet limited data exist on outcomes in the era of the HeartMate 3 device.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 193 patients who underwent HeartMate 3 LVAD implantation at a tertiary care academic medical center between July 2016 and July 2023. Patients were stratified by preoperative estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m² (control, <em>n</em> = 154) vs &lt;30 (advanced kidney disease, <em>n</em> = 39). Outcomes included survival and the need for renal replacement therapy (RRT).</div></div><div><h3>Results</h3><div>At 30 days post-implantation, survival was lower in advanced kidney disease patients compared with controls (84.6% vs 94.2%, <em>p</em> = 0.04). However, survival at 1 year (79.5% vs 79.9%, <em>p</em> = 0.87) and 2 years (73.9% vs 68.7%, <em>p</em> = 0.60) did not differ significantly. Post-implantation RRT was required in 30.3% of advanced kidney disease patients and 18.2% of controls (<em>p</em> = 0.18).</div></div><div><h3>Conclusions</h3><div>Although early postoperative mortality is higher, patients with advanced CKD undergoing HeartMate 3 LVAD implantation achieve comparable 1- and 2-year survival to controls. These findings suggest LVAD implantation may be a reasonable option in carefully selected patients with advanced kidney disease.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100422"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521156","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":"Histidine-rich glycoprotein ameliorated lung ischemia-reperfusion injury in a mouse model","authors":"Yujiro Kubo MD, PhD ,&nbsp;Seiichiro Sugimoto MD, PhD ,&nbsp;Daiki Ousaka PhD ,&nbsp;Dengli Wang PhD ,&nbsp;Toshiaki Ohara MD, PhD ,&nbsp;Toshio Shiotani MD, PhD ,&nbsp;Shin Tanaka MD, PhD ,&nbsp;Ken Suzawa MD, PhD ,&nbsp;Kazuhiko Shien MD, PhD ,&nbsp;Kentaroh Miyoshi MD, PhD ,&nbsp;Mikio Okazaki MD, PhD ,&nbsp;Yasuyuki Hosono MD, PhD ,&nbsp;Akihiro Matsukawa MD, PhD ,&nbsp;Shinichi Toyooka MD, PhD","doi":"10.1016/j.jhlto.2025.100453","DOIUrl":"10.1016/j.jhlto.2025.100453","url":null,"abstract":"<div><h3>Background</h3><div>Histidine-rich glycoprotein (HRG) is a multifunctional plasma glycoprotein involved in the regulation of various biological processes. Decreased plasma levels of HRG at 72 h after lung transplantation have been shown to be associated with severe primary graft dysfunction and poor transplant outcomes. In this study, we examined the effect of HRG supplementation on lung ischemia-reperfusion injury (IRI) in mice.</div></div><div><h3>Methods</h3><div>The experimental mice were divided into a Sham group and three IRI groups (n=5 each) that received phosphate-buffered saline, human serum albumin, or HRG (HRG/IRI group), respectively. The lung function, lung injury, neutrophil infiltration, cellular apoptosis, inflammatory mediators, neutrophil extracellular traps (NETs), translocation status of high-mobility group box 1 (HMGB1), and hemolytic products in the injured tissue/plasma were compared among the groups.</div></div><div><h3>Results</h3><div>The HRG/IRI group showed significantly improved oxygenation capacity and a reduced severity of lung injury as compared with the other IRI groups. The HRG/IRI group also showed significantly less severe tissue inflammation in the reperfused lung, including a lower level of neutrophil infiltration, apoptotic cells, and neutrophil-associated inflammatory mediators than the other IRI groups. Moreover, formation of NETs and HMGB1 translocation were significantly suppressed in the HRG/IRI group as compared with the other IRI groups. A significantly greater degree of scavenging of hemolytic products was observed in the HRG/IRI group than the other IRI groups.</div></div><div><h3>Conclusion</h3><div>HRG supplementation ameliorated lung IRI in mice by suppressing inflammatory responses triggered by neutrophil-associated factors, including formation of NETs, HMGB1 translocation, and accumulation of hemolytic products.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100453"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736370","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":"Parasitic diseases in heart transplantation: challenges of Toxoplasmosis and Chagas Disease","authors":"Alexandre Mestre Tejo MD ,&nbsp;Silvia Vidal Campos PhD","doi":"10.1016/j.jhlto.2025.100450","DOIUrl":"10.1016/j.jhlto.2025.100450","url":null,"abstract":"<div><div>Parasitic diseases have always caused a significant burden in endemic countries. However, due to globalization and immigration, more cases are emerging in non-endemic regions, leading to a growing incidence in solid organ transplantation. These immunocompromised patients, such diseases, have the potential to reactivate and cause severe disease and graft damage, often leading to death. Two specific parasites play a special role in the heart transplant scenario: <em>Trypanosoma cruzi</em>, responsible for Chagas disease, and T<em>oxoplasma gondii</em>, for Toxoplasmosis. In endemic countries, Chagas disease is not only one of the main indications for a heart transplant, but also responsible for several episodes of reactivation after transplantation, requiring careful surveillance for preemptive treatment. <em>T. gondii</em> has the potential to reactivate in immunocompromised hosts, leading to myocarditis and/or disseminated disease, often fatal. Prophylaxis is safe and effective to prevent reactivation. This review aims to summarize the most important aspects of Chagas disease and Toxoplasmosis in the heart transplant setting, with emphasis on pre-transplant screening, prophylaxis, and monitoring.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100450"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839590","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":"Thrombin generation in HeartMate 3 patients on apixaban and vitamin K antagonists: Variability limits clinical applicability","authors":"Charlotte J. Van Edom MD ,&nbsp;Walter Droogné MD ,&nbsp;Steven Jacobs MD, PhD ,&nbsp;Marc Jacquemin MD PhD ,&nbsp;Christine Van Laer PhD ,&nbsp;Joeri Van Puyvelde MD, PhD ,&nbsp;Dirk Vlasselaers MD, PhD ,&nbsp;Katrien Vandersmissen ,&nbsp;Thomas Vanassche MD, PhD ,&nbsp;Bart Meyns MD, PhD","doi":"10.1016/j.jhlto.2025.100447","DOIUrl":"10.1016/j.jhlto.2025.100447","url":null,"abstract":"<div><div>Apixaban is increasingly replacing vitamin K antagonists (VKAs) during HeartMate 3 (HM3) left ventricular assist device support, but its pharmacodynamics in this setting remain poorly understood. Thrombin generation assays (TGAs) allow for comparison of the overall anticoagulant effect. TGAs were performed in 24 HM3 patients on apixaban, dosed to maintain trough levels &gt;50 ng/liter, and 6 on VKAs with target INR 2 to 3, without recent coagulopathy. Apixaban was associated with shorter lag time and time-to-peak thrombin generation, indicating faster coagulation initiation. Endogenous thrombin potential (ETP) was higher with apixaban, but both peak thrombin and ETP showed high interindividual variability. Apixaban levels correlated modestly with initiation parameters, but not with ETP or peak thrombin. These findings demonstrate pharmacodynamic differences between apixaban and VKAs, but also highlight substantial variability and limited clinical applicability for apixaban dose titration. TGAs should therefore be regarded as research tools rather than monitoring assays in this setting.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100447"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839582","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":"Survival improvement with sirolimus plus tacrolimus immunosuppression for treatment of bronchiolitis obliterans syndrome after lung transplantation","authors":"Marniker Wijesinha PhD ,&nbsp;Michael Terrin MD ,&nbsp;Si Pham MD ,&nbsp;Aldo Iacono MD","doi":"10.1016/j.jhlto.2025.100469","DOIUrl":"10.1016/j.jhlto.2025.100469","url":null,"abstract":"<div><h3>Background</h3><div>Chronic rejection, usually manifesting as bronchiolitis obliterans syndrome (BOS), is the leading cause of death among lung transplant patients. Prior lung transplant studies showed higher overall survival and lower BOS incidence associated with sirolimus (SIR) + tacrolimus (TAC) versus conventional mycophenolate mofetil (MMF) + TAC immunosuppression. However, after BOS occurs, it is unknown how immunosuppressive drugs may be linked to survival.</div></div><div><h3>Methods</h3><div>This study included U.S. lung transplant recipients in the Lung Allocation Score era (starting May 2005), with a BOS diagnosis documented from 2006 to 2020, in the Scientific Registry of Transplant Recipients dataset. Survival was compared between patients receiving MMF+TAC, SIR+TAC, or SIR+TAC+MMF/azathioprine (SIR+TAC+MMF/AZA) after BOS onset, using multivariable adjusted Cox regression and Inverse Probability of Treatment Weighting (IPTW)-adjusted Kaplan-Meier estimates.</div></div><div><h3>Results</h3><div>SIR+TAC+MMF/AZA (HR=0.60, p=0.03, n=47) and SIR+TAC (HR=0.67, p=0.04, n=95) were associated with better survival than MMF+TAC (n=1012); each group contained patients from &gt;15 centers. IPTW-adjusted survival probabilities for SIR+TAC+MMF/AZA, SIR+TAC, and MMF+TAC, respectively, were, 1-year: 91%, 84%, 80% and 5-year: 50%, 58%, 42%. Within severely affected BOS patients (BOS Grade 3, or FEV₁ decrease ≥30%/year, or FEV₁&lt;25% of predicted at BOS documentation), SIR+TAC+MMF/AZA (HR=0.32, p=0.03) and SIR+TAC (HR=0.50, p=0.05) had larger survival advantages over MMF+TAC; the respective survival probabilities were, 1-year: 91%, 70%, 59%, and 5-year: 41%, 35%, 20%.</div></div><div><h3>Conclusions</h3><div>Sirolimus + tacrolimus immunosuppression may improve survival in BOS patients, especially severely affected patients with BOS Grade 3, or rapidly declining or low FEV₁. Adding MMF or azathioprine to this combination may further increase short-term survival.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100469"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026158","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":"Listing patterns at the highest volume heart transplant centers: Multiple roads to transplant","authors":"Joshua A. Rushakoff MD, MPP ,&nbsp;Adam D. DeVore MD, MHS ,&nbsp;Richa Agarwal MD ,&nbsp;Joseph B. Lerman MD ,&nbsp;Karen Flores Rosario MD ,&nbsp;Jeffrey Keenan MD ,&nbsp;Jacob N. Schroder MD ,&nbsp;Carmelo A. Milano MD ,&nbsp;Chetan B. Patel MD","doi":"10.1016/j.jhlto.2025.100479","DOIUrl":"10.1016/j.jhlto.2025.100479","url":null,"abstract":"<div><div>The current heart transplantation (HT) allocation system added additional progressive statuses to differentiate the highest risk patients and decrease waitlist mortality. We analyzed United Network for Organ Sharing thoracic organ data (10/18/2018-6/30/2025) to assess listing practices at the 10 highest volume centers (5,466 total HT). We found variation in the final waitlist status across these centers (status 1 3.6% to 16.4%; status 6 0.5%-14.5%). Further, some centers had more even distributions across final status, while others had dominant status 2 patterns. As continuous distribution allocation is considered for HT, we feel it is critical to consider the practice patterns of these highest-volume centers. Notably, HT candidates may not conform to a prescribed course through escalating statuses.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100479"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026192","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":"Kaposi sarcoma in lung transplant recipients with public health service increased-risk donors: A retrospective cohort study and review of the literature","authors":"Shoaib Ahmad MD ,&nbsp;Curt Bay PhD ,&nbsp;Michael D. Nailor PharmD ,&nbsp;Christine Pham PharmD ,&nbsp;Ross M. Bremner MD, PhD ,&nbsp;Ali Imran Saeed MD ,&nbsp;Kellie J. Goodlet PharmD ,&nbsp;Sofya Tokman MD","doi":"10.1016/j.jhlto.2025.100468","DOIUrl":"10.1016/j.jhlto.2025.100468","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the relationship between Public Health Service (PHS) increased-risk donors and post-lung transplant (LT) Kaposi sarcoma (KS).</div></div><div><h3>Methods</h3><div>This retrospective cohort study included LT recipients (April 1, 2019-April 1, 2024) who had PHS increased-risk donors at our institution. Data were abstracted from UNOS and electronic medical records. Published post-LT KS cases were also reviewed. Descriptive statistics and Kaplan–Meier estimates were used.</div></div><div><h3>Results</h3><div>Of 467 LT recipients, 90 (23.9%) had PHS increased-risk donors, including 13 [14.4%] men who have sex with men (MSM). Four of these 13 (30.8%) recipients developed KS (median time to diagnosis, 365 days [IQR 276–502]). Basiliximab was the most common induction agent; all 4 patients were on standard 3-drug immunosuppression. All 4 recipients had pulmonary KS without extrapulmonary involvement and positive human herpes virus 8 (HHV-8) immunohistochemistry results. Pulmonary nodules were incidentally noted on chest CT in 3 asymptomatic patients; 1 patient presented with dyspnea and central airway obstruction. Immunosuppression was reduced and mTOR inhibitors were initiated for all 4 patients; 1 patient underwent stenting of the left main bronchus and radiation, and 1 was treated with liposomal doxorubicin. Three recipients improved, and 1 is awaiting follow-up imaging (median follow-up, 276 days [IQR 177–433]). In our data pooled with 15 published cases, mean survival time was lower in patients with disseminated KS (182 vs. 563 days, p=0.011).</div></div><div><h3>Conclusion</h3><div>LT recipients with MSM donors may be at an increased risk for post-LT KS from donor-derived HHV-8. Larger, more definitive, multicenter studies are needed.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100468"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975967","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":"Veno-venous versus Veno-arterial extracorporeal membrane oxygenation for the management of primary graft dysfunction following lung transplantation: A systematic review and meta-analysis","authors":"Erlon de Avila Carvalho MD, PhD ,&nbsp;Bruna Carregal Coelho MSc ,&nbsp;Rachid Eduardo Noleto da Nobrega Oliveira MD, MS ,&nbsp;Lucas Monteiro Delgado MSc ,&nbsp;Felipe S. Passos MD ,&nbsp;Tulio Caldonazo MD ,&nbsp;Marcelo Cypel MD, PhD","doi":"10.1016/j.jhlto.2025.100437","DOIUrl":"10.1016/j.jhlto.2025.100437","url":null,"abstract":"<div><h3>Background</h3><div>Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplantation. In its severe forms, extracorporeal membrane oxygenation (ECMO) may be required. However, there is no consensus on whether venovenous (VV) or venoarterial (VA) ECMO modality provides superior outcomes. The objective of this meta-analysis is to compare the use of VV-ECMO versus VA-ECMO in the management of grade 3 PGD after lung transplantation.</div></div><div><h3>Methods</h3><div>Three databases were assessed. Primary outcome was overall survival (OS). Secondary outcomes included cerebrovascular complications, incidence of pneumonia, reintubation, acute kidney injury, ICU length of stay and ECMO duration. Hazard ratios (HR), odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated. Reconstruction of time-to-event data and sensitivity analyses were performed for the primary endpoint.</div></div><div><h3>Results</h3><div>Four studies including 210 patients (VV-ECMO: 142; VA-ECMO: 68) were analyzed. VV-ECMO was associated with improved early survival (HR 0.41; 95%CI 0.22 to 0.76; p=0.005) within the first 2 months after transplantation, although no significant difference was observed in long-term survival (HR 0.72; 95%CI 0.46 to 1.15; p=0.168). Cerebrovascular complications occurred significantly more often in the VA-ECMO group (OR 18.33; 95%CI 3.62 to 92.81; p=0.0004), while no significant differences were found in pneumonia, reintubation, acute renal failure, ICU length of stay, or ECMO duration.</div></div><div><h3>Conclusion</h3><div>VV-ECMO appears to be associated with better short-term survival and fewer neurological complications compared to VA-ECMO in patients with grade 3 PGD after lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100437"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684707","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}