JHLT Open最新文献

{"title":"T cell immune senescence is associated with frailty and sarcopenia in lung transplant candidates","authors":"Joanna M. Schaenman MD, PhD ,&nbsp;Harry Pickering PhD ,&nbsp;Elaine F. Reed PhD ,&nbsp;Maura Rossetti PhD ,&nbsp;Benjamin Seligman MD ,&nbsp;S. Samuel Weigt MD ,&nbsp;Michael Shino MD ,&nbsp;David Sayah MD, PhD ,&nbsp;John Belperio MD ,&nbsp;Ashley Hu MD ,&nbsp;Ashley Prosper MD ,&nbsp;Kathleen Ruchalski MD ,&nbsp;Abbas Ardehali MD ,&nbsp;Reshma Biniwale MD","doi":"10.1016/j.jhlto.2024.100199","DOIUrl":"10.1016/j.jhlto.2024.100199","url":null,"abstract":"<div><h3>Backgound</h3><div>Older lung transplant recipients experience increased rates of adverse clinical outcomes, including infection compared with younger patients, potentially related to impaired cell-mediated immunity, frailty, and sarcopenia.</div></div><div><h3>Methods</h3><div>Patients over age 55 years undergoing evaluation for lung transplantation were evaluated for sarcopenia by cross-sectional area and average attenuation of the pectoralis major muscle on chest computed tomography. Frailty was measured using the Fried Frailty Phenotype. Immune phenotyping was performed using multichannel flow cytometry of peripheral blood mononuclear cells (PBMC) in a total of 26 lung transplant candidates.</div></div><div><h3>Results</h3><div>The median patient age was 65, primarily with restrictive lung disease (76.9%). Hospital readmission was associated with lower frequency of naïve CD4 (<em>p</em> = 0.004) and CD8 T cells (<em>p</em> = 0.026). Senescent CD4 (KLRG1+/CD28−) and CD8 T cells were also associated with readmission (<em>p</em> = 0.014 and <em>p</em> = 0.013, respectively), and senescent CD4 T cells were predictive of total hospital time (<em>p</em> = 0.003). TEMRA CD4 T cells were significantly associated with frailty (<em>p</em> = 0.015) and sarcopenia (<em>p</em> = 0.011). Senescent CD4 and CD8 T cells were significantly associated with sarcopenia (<em>p</em> = 0.009 and <em>p</em> = 0.006, respectively).</div></div><div><h3>Conclusions</h3><div>These findings suggest that impaired cell-mediated immunity may underlie the associations between frailty and sarcopenia and poor clinical outcomes. A multifaceted approach to evaluation of older patients has the potential to improve risk stratification and inform management of immunosuppression.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172818","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":"Evaluation of Elexacafor/Tezacaftor/Ivacaftor therapy after lung transplantation in Cystic Fibrosis: The Dutch National KOALA study","authors":"On behalf of the KOALA study group,&nbsp;Johanna P. van Gemert ,&nbsp;Bart Luijk ,&nbsp;Merel E. Hellemons ,&nbsp;Klara A. Visser ,&nbsp;Carina.M.E. Hansen ,&nbsp;Renske van der Meer ,&nbsp;C. Tji Gan ,&nbsp;Hester van der Vaart ,&nbsp;Onno W. Akkerman ,&nbsp;Willie N. Steenhuis ,&nbsp;Marieke Verkleij ,&nbsp;Harry G.M. Heijerman ,&nbsp;Erik A.M. Verschuuren","doi":"10.1016/j.jhlto.2025.100210","DOIUrl":"10.1016/j.jhlto.2025.100210","url":null,"abstract":"<div><h3>Background</h3><div>Elexacaftor/Tezacaftor/Ivacaftor (ETI) for people with CF (PwCF) after lung transplantation (LTx) has been restrained due to uncertainties regarding efficacy and drug interactions. Given the persistence of extrapulmonary symptoms post-LTx, this prospective study aims to investigate the benefits and safety of ETI for PwCF post-LTx.</div></div><div><h3>Methods</h3><div>Between Nov 2022-Nov 2023 ETI was offered to PwCF post-LTx with at least one F508del mutation in 3 Dutch LTx centers. PwCF were considered eligible if they had either a BMI ≤ 19 kg/m², chronic rhinosinusitis (CRS), uncontrolled diabetes or gastrointestinal (GI) symptoms. BMI, HbA1c, SNOT-22 score, GI Symptom Tracker, CF Questionnaire-Revised (CFQ-R), FEV₁, creatinine, changes in calcineurin inhibitor (CNI) doses and levels were compared between baseline and 3 months follow-up.</div></div><div><h3>Results</h3><div>Fifty-five PwCF post-LTx were included, of whom 5 were excluded because of ETI discontinuation due to side effects, within 3 month follow-up. Three months results showed a decrease in SNOT-22 score (<em>p</em>&lt; 0.001) and GI symptoms (all 4, <em>p</em>&lt; 0.05), an increase in BMI (<em>p</em>= 0.012) and CFQ-R (6 domains, <em>p</em>&lt; 0.05). Median CNI daily dose had to be reduced from 6 to 4 mg (<em>p</em>&lt; 0.001), to maintain stable CNI trough levels. Creatinine increased from 110 (87−141) to 115 (92−125) umol/L (<em>p</em>= 0.002).</div></div><div><h3>Conclusion</h3><div>ETI for PwCF post-LTx shows favorable effects on CRS, GI symptoms, and quality of life, but not on BMI and HbA1c. Due to its high cost, careful consideration and further studies are required. Monitoring renal function and CNI trough levels is recommended.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100210"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172822","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":"Ventricular assist device implantation in children with a mechanical valve: An ACTION registry analysis","authors":"Sabena F. Hussain MD, MSc ,&nbsp;Elyse Miller MD ,&nbsp;Othman Aljohani MBBS, MPH ,&nbsp;Scott Auerbach MD ,&nbsp;David Bearl MD ,&nbsp;Victor Benvenuto MD ,&nbsp;Erica Bonura MD ,&nbsp;Richard L. Crawford ,&nbsp;Anna Joong MD ,&nbsp;Jameson Dyal MD ,&nbsp;Christina Hartje-Dunn MD ,&nbsp;Sujit Jana MD ,&nbsp;Sonia Kaushal MD ,&nbsp;Melanie Lynn MD ,&nbsp;Joseph Spinner MD ,&nbsp;Laura Radel MD ,&nbsp;Alexander Raskin MD ,&nbsp;Diana Torpoco-Rivera MD ,&nbsp;Sarah J. Wilkens MD, MPH ,&nbsp;Chet R. Villa MD","doi":"10.1016/j.jhlto.2024.100198","DOIUrl":"10.1016/j.jhlto.2024.100198","url":null,"abstract":"<div><h3>Background</h3><div>Patients with congenital heart disease (CHD) frequently have had valve interventions, including replacement with a mechanical valve (mechV). The impact of a mechV on clinical outcomes in patients undergoing ventricular assist device (VAD) implantation is not well characterized.</div></div><div><h3>Objectives</h3><div>This study assessed VAD outcomes in patients with CHD and a mechV.</div></div><div><h3>Methods</h3><div>All patients with a history of CHD (<em>n</em> = 433) in the Advanced Cardiac Therapies Improving Outcomes Network database were included in the study (January 2012-January 2023). Patient characteristics and outcomes were assessed among patients with a mechV and without a mechV.</div></div><div><h3>Results</h3><div>Twenty-seven (6%) patients with CHD had a mechV at VAD implantation. Fourteen (52%) of the patients with mechV had univentricular anatomy and 13 (48%) had biventricular anatomy. Patients with mechV were older (4.9 vs 1.9 years, <em>p</em> = 0.02), smaller (14.9 vs 10.6 kg, <em>p</em> = 0.02), and had a higher interagency registry for mechanically assisted circulatory support profile (<em>p</em> = 0.01). Three (11%) patients with mechV experienced a valve-related complication. There was no difference in survival (<em>p</em> = 0.4) or ischemic stroke frequency (11% vs 13%, <em>p</em> = 1) between patients with mechV and non-mechV. Patients with mechV had higher frequency of hemorrhagic stroke (18% vs 4.7%, <em>p</em> = 0.01) and major bleeding (44% vs 26%, <em>p</em> = 0.04).</div></div><div><h3>Conclusions</h3><div>Patients with CHD with a mechV have similar survival to patients with non-mechV; however, there is higher risk of bleeding including hemorrhagic stroke.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173258","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":"Effects of macitentan and selexipag across prognostic age groups in patients with pulmonary arterial hypertension","authors":"Richard Channick MD ,&nbsp;Sarah Medrek MD ,&nbsp;Marion Delcroix MD ,&nbsp;Sean Gaine MD ,&nbsp;Pavel Jansa MD, PhD ,&nbsp;Irene Lang MD ,&nbsp;Vallerie McLaughlin MD ,&nbsp;Sanjay Mehta MD ,&nbsp;Tomas Pulido MD ,&nbsp;Bhagavatula Sastry MD ,&nbsp;Rogerio Souza MD, PhD ,&nbsp;Adam Torbicki MD ,&nbsp;Carol Zhao MS ,&nbsp;Paul Strachan MD ,&nbsp;Peter Agron PhD ,&nbsp;Joseph Yen PhD ,&nbsp;Olivier Sitbon MD, PhD","doi":"10.1016/j.jhlto.2024.100197","DOIUrl":"10.1016/j.jhlto.2024.100197","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Age affects disease severity and patient outcomes in pulmonary arterial hypertension. This post-hoc analysis identified prognostic age groups and associated macitentan/selexipag treatment effects.</div></div><div><h3>METHODS</h3><div>Randomized trials evaluated macitentan (SERAPHIN; NCT00660179) and selexipag (GRIPHON; NCT01106014) versus placebo (primary endpoint: time to morbidity/mortality [M/M]). This analysis defined age thresholds differentiating M/M risk in patients randomized to placebo (Cox regression determining treatment effect by age).</div></div><div><h3>RESULTS</h3><div>Three age groups (&lt; 35, 35–64, ≥ 65 years) showed good M/M risk discrimination (c-statistic 0.69, SERAPHIN; 0.66, GRIPHON). M/M risk was higher in placebo patients &lt; 35 versus 35–64 years (SERAPHIN: hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.10–2.72, <em>p</em> = 0.02; GRIPHON: HR 1.81, 95% CI 1.28–2.56, <em>p</em> &lt; 0.001). M/M risk trended higher in patients ≥ 65 versus 35–64 years (SERAPHIN: HR 1.55, 95% CI 0.89–2.69, <em>p</em> = 0.12; GRIPHON (HR 1.08, 95% CI 0.75–1.55, <em>p</em> = 0.69). M/M risk was lower with macitentan/selexipag versus placebo: macitentan &lt; 35 (HR 0.44, 95% CI 0.25–0.78; <em>p</em> = 0.005), 35–64 (HR 0.50, 95% CI 0.33–0.76; <em>p</em> &lt; 0.001), ≥ 65 years (HR 0.69, 95% CI 0.30–1.58; <em>p</em> = 0.38); selexipag &lt; 35 (HR 0.50, 95% CI 0.32–0.78; <em>p</em> = 0.002), 35–64 (HR 0.72, 95% CI 0.54–0.96; <em>p</em> = 0.03), ≥ 65 years (HR 0.55, 95% CI 0.33–0.91; <em>p</em> = 0.02). Adverse-event discontinuations were similar.</div></div><div><h3>CONCLUSIONS</h3><div>The benefit (vs placebo) of macitentan/selexipag on reducing risk of M/M events was consistent across all ages, including the younger group where significant treatment effects were observed.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172821","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":"Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS Database","authors":"Jennifer Conway MD ,&nbsp;Tara Pidborochynski MSc ,&nbsp;James K. Kirklin MD ,&nbsp;Ryan Cantor PhD ,&nbsp;Hong Zhao PhD ,&nbsp;Aryaz Sheybani MD ,&nbsp;Jacqueline Lamour MD ,&nbsp;Lakshmi Gokanapudy Hahn MD ,&nbsp;Leslie Collins MD ,&nbsp;Jessica Laks MD ,&nbsp;Darren H. Freed MD, PhD","doi":"10.1016/j.jhlto.2024.100184","DOIUrl":"10.1016/j.jhlto.2024.100184","url":null,"abstract":"<div><h3>Background</h3><div>Primary graft failure (PGF) is a leading cause of early morbidity and mortality after heart transplantation (HTx). PGF is secondary to graft ischemia and ischemia-reperfusion injuries to the cardiomyocytes and vasculature of the donor heart after transplantation. Longer-term outcomes after PGF are not well studied.</div></div><div><h3>Methods</h3><div>Patients with an HTx (January 1, 2010 to June 30, 2022) were identified using the Pediatric Heart Transplant Society registry. PGF was defined as death, retransplantation, or need for mechanical circulatory support within 72 hours of HTx. Kaplan-Meier analysis and Cox proportional hazard modeling were utilized.</div></div><div><h3>Results</h3><div>Of the 4,982 patients with a primary HTx, 5.4% (<em>n</em> = 269) met criteria for PGF. Patients with PGF were younger, with higher proportion of congenital heart disease, longer cardiopulmonary bypass and ischemic times (IT), and more likely to be on extracorporeal membrane oxygenation or ventilator at HTx (all <em>p</em> &lt; 0.0001, IT <em>p</em> = 0.0006). PGF resulted in lower overall survival (1 year: 54% vs 94%, <em>p</em> &lt; 0.001). This remained true when conditional survival was examined at 30 and 90 days but not at 1 year (<em>p</em> = 0.1143). Freedom from rejection did not differ between the groups at overall or conditional on 30 days but was slightly higher for those with PGF at 90 and 365 days. There was no difference in freedom from coronary allograft vasculopathy (CAV). PGF was an independent predictor of overall graft loss (hazard ratios [HR] 4.7, <em>p</em> &lt; 0.0001) and conditional survival to 30 days (HR 2.47, <em>p</em> &lt; 0.0001) and 90 days (HR 1.6, <em>p</em> = 0.012) but not beyond 1 year.</div></div><div><h3>Conclusions</h3><div>Severe PGF is an independent predictor of early mortality post-HTx but subsequently does not further impact long-term survival, overall risk of rejection, or CAV. Understanding the impact of milder forms of PGF on survival and long-term outcomes is still needed. Methods to decrease the risk of PGF, such as alternative preservation and storage techniques, may impact early mortality post-HTx.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100184"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173255","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":"Association of liver biopsy pathology on outcome of patients undergoing heart transplantation","authors":"Lauren S. Eichenwald MD ,&nbsp;Raffi Karagozian MD ,&nbsp;Adam J. Eichenwald PhD ,&nbsp;John Morrissey MD MBA ,&nbsp;Saurav Kini MD ,&nbsp;Ariella Stein MSCIS-HI ,&nbsp;Amanda R. Vest MBBS MPH","doi":"10.1016/j.jhlto.2024.100187","DOIUrl":"10.1016/j.jhlto.2024.100187","url":null,"abstract":"<div><h3>Background</h3><div>Patients with advanced heart failure needing heart transplant commonly suffer liver dysfunction. However, there is limited data on the impact of liver fibrosis on outcomes for heart transplant (HT) candidates. We determine the relationship between liver fibrosis severity and mortality rates for HT patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of adults listed for HT who underwent a liver biopsy for evaluation of early or advanced liver fibrosis from August 12, 2004 to February 16, 2022. Trend analysis was performed using Cox proportional hazard model, controlling for MELD-XI. At-risk period starts at the time of waitlist; the end of the follow-up period was mortality on the waitlist, mortality post-HT, or administrative censoring at the end of the study.</div></div><div><h3>Results</h3><div>There was no significant difference in the survival of patients with advanced fibrosis and early fibrosis over time (HR 1.54, CI 0.59–4.02, <em>p</em> = 0.5). Similarly, there was also no significant survival difference within groups who did (HR 0.78, CI = 0.26–2.33, <em>p</em> = 0.8) or did not (HR 1.00, CI 0.09–11.43, <em>p</em> = 0.9) receive transplants. However, most transplants were performed in patients with no or early fibrosis.</div></div><div><h3>Conclusion</h3><div>There was no significant difference in the survival rates between HT candidates with and without advanced fibrosis on the waitlist and post-HT, challenging the notion that advanced fibrosis should be an absolute contraindication for HT. However, our findings are limited by the small sample size, retrospective design, and focus on patients already deemed suitable for transplantation. These limitations highlight the need for prospective studies involving broader patient populations, including those excluded from transplant candidacy due to severe fibrosis or cirrhosis. Future research should evaluate whether pre-transplant liver biopsy is necessary for all HT candidates or if clinical assessments can adequately stratify risk.</div></div><div><h3>Lay summary</h3><div>This study found that the presence of advanced liver injury did not confer a difference in the waitlist and post heart transplant (HT) survival rates of patients on the HT transplant list. This finding suggests that patients listed for transplant may not need to undergo a liver biopsy as part of the transplant work up.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173866","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":"Concomitant abdominal organ transplantation alongside lung transplantation: An ISHLT transplant database analysis","authors":"Renita Wilson BS ,&nbsp;J. Asher Jenkins MD ,&nbsp;Juan Maria Farina MD ,&nbsp;Blake Langlais MS ,&nbsp;Bashar Aqel MD ,&nbsp;Ashraf Omar MD ,&nbsp;Jonathan D’Cunha MD, PhD ,&nbsp;Pedro Reck dos Santos MD, PhD","doi":"10.1016/j.jhlto.2024.100200","DOIUrl":"10.1016/j.jhlto.2024.100200","url":null,"abstract":"<div><h3>Background</h3><div>Concomitant abdominal organ transplant of the liver, kidney, and/or pancreas with lung transplant (Con-AbLTx) may be considered for appropriate patients who present with end-stage disease of multiple organ systems. Most existing literature examines outcomes of combined lung-liver transplants, with little attention paid to other commonly transplanted abdominal organs, such as kidneys and pancreas. This study aims to examine post-transplant outcomes of patients submitted to Con-AbLTx to lung transplant (LTx)-only recipients.</div></div><div><h3>Methods</h3><div>The international society for heart and lung transplantation (ISHLT) International Thoracic Organ Transplant Registry for Con-AbLTx and LTx-only was reviewed from January 1994 to June 2018. LTx-only recipients were propensity score matched 4:1 based on various patient characteristics. Data were analyzed with Fisher’s exact, Wilcoxon rank sum tests, Kaplan-Meier methods, and Cox proportional hazards where appropriate.</div></div><div><h3>Results</h3><div>A total of 195 Con-AbLTx and 780 propensity-matched LTx-only cases were compared. LTx-only recipients demonstrated higher levels of bronchiolitis obliterans syndrome. Following transplant, Con-AbLTx required a longer hospital stay and post-transplant dialysis before discharge. LTx-only were more likely to experience graft failure from acute rejection or chronic rejection. Con-AbLTx experienced higher 1-year mortality than LTx-only counterparts, with the highest mortality seen in the concomitant lung/kidney group. Of concomitant transplants, lung/liver recipients had greater survival over time.</div></div><div><h3>Conclusions</h3><div>Con-AbLTx has the potential to carry substantial morbidity. At 10 years post-transplant, there is no statistically significant difference in survival between LTx-only and Con-AbLTx recipients. Given limited organ availability and ethical considerations of simultaneous transplant, careful consideration for Con-AbLTx is paramount to achieve acceptable outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173259","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":"Heart transplantation in South America: Risk factors, challenges, and opportunities","authors":"Renzo Y. Loyaga-Rendon MD, PhD, MSPH ,&nbsp;Deepak Acharya MD, MSPH","doi":"10.1016/j.jhlto.2024.100186","DOIUrl":"10.1016/j.jhlto.2024.100186","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173784","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":"Challenges in advanced heart failure care in Japan: Bridging the gap in durable mechanical circulatory support utilization and heart transplantation","authors":"Satoshi Miyashita MD ,&nbsp;Francisco B. Alexandrino MD ,&nbsp;Amanda R. Vest MBBS, MPH ,&nbsp;Tomohiro Fujisaki MD ,&nbsp;Wai Hong Wilson Tang MD ,&nbsp;Yasumasa Tsukamoto MD, PhD ,&nbsp;Koichiro Kinugawa MD, PhD","doi":"10.1016/j.jhlto.2024.100204","DOIUrl":"10.1016/j.jhlto.2024.100204","url":null,"abstract":"<div><div>In Japan, the incidence of heart failure has escalated to become a major cause of morbidity and mortality. Advanced therapeutic interventions, such as heart transplantation and durable left ventricular assist devices, have become a focus of interest in recent decades. However, the unique sociocultural landscape of Japan, coupled with a historically controversial background of organ transplantation, has impeded progress in these areas. This has resulted in a notable donor shortage and the absence of a robust framework for heart transplantation. This review aims to highlight the specific challenges faced in advancing heart failure care in Japan and proposes strategic solutions to overcome these barriers.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173785","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":"Surgeons are apprehensive to use DCD lungs despite similar post-transplant outcomes: A 20-year UNOS retrospective analysis","authors":"J. Sam Meyer MSc ,&nbsp;Oliver K. Jawitz MD, MHS ,&nbsp;Yury Peysakhovich MD ,&nbsp;Dan Aravot MD ,&nbsp;Matthew G. Hartwig MD, MHS ,&nbsp;Yaron D. Barac MD, PhD","doi":"10.1016/j.jhlto.2024.100185","DOIUrl":"10.1016/j.jhlto.2024.100185","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;As rates of lung transplants in the US grow, waitlist mortality increases. While the literature reports similar survival outcomes of DBD and DCD transplants, research should investigate improvements to DCD lung recovery protocols to increase the total number recovered. Recently, Choi et al. presented donor variables indicative of ultimate lung recovery&lt;sup&gt;1&lt;/sup&gt;. However, expansion of DCD lung transplants requires a comparison of these indicators to DBD donors for application of similar parameters to increase the rate of DCD lung recovery to ensure that viable DCD organs are not discarded due to overly stringent donor and organ requirements.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We performed a retrospective analysis of United Network for Organs Sharing (UNOS) Organ Procurement and Transplantation Network/UNOS STAR (Standard Analysis and Research) database. Donors who donated ≥1 organ from 10/1999–01/2019 were extracted and stratified according to DBD and DCD status. Associated characteristics of potential DCD and DBD lung donors were compared, and a multivariable logistic regression model with ≥1 transplanted lung was constructed to evaluate the independent effects of important predictors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our data included 179,228 potential lung donors, 162,157 DBD (31,486 donated, 19.4% recovery) and 17,071 DCD (526 donated, 3.1% recovery). Odds of lung non-use between DBD and DCD donors were significantly associated with blood type, alcohol use, cause of death, smoking history, drug use, death circumstance, ethnicity, gender, hypertension, cancer, age, and lung pO2 on 100% P/F ratio (&lt;em&gt;P&lt;/em&gt; &lt; 0.001 for all variables). A multivariable regression analysis showed that the odds of a potential DCD donating lungs is 75% lower than (&lt;em&gt;P&lt;/em&gt; &lt; 0.001) that of a potential DBD when the cause of death (COD) is stroke, head trauma (44% lower &lt;em&gt;P&lt;/em&gt; = 0.076), CNS tumor (22% lower &lt;em&gt;P&lt;/em&gt; = 0.174) or MVA (69% lower &lt;em&gt;P&lt;/em&gt; = 0.183). A history of diabetes for over 10 years was strongly associated with non-use for DCD lungs (OR, 0.87, &lt;em&gt;P&lt;/em&gt; = 0.71), whereas an under 10-year history was associated with increased use (OR 2.33, &lt;em&gt;P&lt;/em&gt; = 0.008, OR 1.07 &lt;em&gt;P&lt;/em&gt; = 0.819).&lt;/div&gt;&lt;div&gt;Lungs from donors ages 40–49 are more likely to be procured than those &lt;30 or &gt;50 in both DBD and DCD. However, likelihood of procurement is 1.84 [95% 1.42, 2.38, &lt;em&gt;p&lt;/em&gt; &lt; 0.001] times higher in 40–49-year-old vs. &lt;30-year-old donors when comparing DBD vs. DCD, and 2.43 [95% 1.83, 3.22, &lt;em&gt;p&lt;/em&gt; &lt; 0.001] times higher than patients &gt;50 in DBD vs DCD donors. In addition, for each era, the odds for procuring DCD vs. DBD lungs consistently improved [95% 1.46–2.57, &lt;em&gt;p&lt;/em&gt; &lt; 0.001].&lt;/div&gt;&lt;div&gt;Rejected DCD lungs were associated with donors with higher cardiopulmonary function. Left ventricular ejection fractions in discarded DCD lung donors were higher than those of discarded DBD lung","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173865","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}