JHLT Open最新文献

{"title":"Medium-term comprehensive outcomes of heart transplantation using donors with hepatitis C viremia to aviremic recipients","authors":"Ritika Mazumder DO ,&nbsp;Sarah Khan MD ,&nbsp;Sakthi Surya Prakash MD ,&nbsp;Qijun Yang MS ,&nbsp;Omar T. Sims PhD ,&nbsp;Randall C. Starling MD, MPH ,&nbsp;William Carey MD","doi":"10.1016/j.jhlto.2025.100467","DOIUrl":"10.1016/j.jhlto.2025.100467","url":null,"abstract":"<div><h3>Background</h3><div>Although direct-acting antiviral (DAA) therapy has enabled successful use of organs from donors with hepatitis C (HCV) with favorable initial results, medium-term outcome data remains insufficient. This study aimed to compare 4-year mortality, primary graft dysfunction, and major adverse cardiac events (MACE) between heart transplants from donors with hepatitis C viremia (D+) and donors without hepatitis C viremia (D−) in aviremic recipients. Medium-term complications, including incidence of rejection, coronary artery vasculopathy (CAV), fibrosing cholestatic hepatitis (FCH), and extrahepatic manifestations of HCV, were also investigated.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 256 (23 D+ and 233 D−) heart transplant recipients at a single institution between 2018 and 2022.</div></div><div><h3>Results</h3><div>Over a 4-year follow-up period, survival was similar between D+ and D− recipients (91.3% [21/23] vs 89.3% [208/233], <em>p</em> = 0.61). The likelihood of death from primary graft dysfunction was similar between D+ and D− groups within a 90-day follow-up period (4.3% vs 2.1%, <em>p</em> = 0.52). The rate of composite MACE was similar in both groups (<em>p</em> = 1.00). Both D+ and D− groups had similar rates of acute cellular rejection (8.7% vs 12.9%, <em>p</em> = 0.94), antibody-mediated rejection (4.3% vs 8.2%, <em>p</em> = 1.00), and CAV (17.4% vs 11.6%, <em>p</em> = 0.27). None of the patients developed fibrosing cholestatic hepatitis. No definitive extra-hepatic manifestations of HCV were noted in D+ recipients.</div></div><div><h3>Conclusion</h3><div>Patient and graft survival rates do not differ between D+ and D− heart transplant recipients. There is no difference in post-transplant complications, including MACE, rejection, CAV, FCH, and extrahepatic manifestations of HCV. These findings suggest medium-term safety in utilizing D+ hearts for enlarging the pool of limited organs.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100467"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924311","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":"Percutaneous management and outcomes of outflow graft obstruction in patients with left ventricular assist device: A single-center experience","authors":"Yu Wu ,&nbsp;Sylvie Baudart ,&nbsp;Richard Cheng ,&nbsp;Kimberly Kallianos ,&nbsp;Ryan Ruaysungnoen ,&nbsp;Jackie DesJardin ,&nbsp;Mandar Aras ,&nbsp;Krishan Soni ,&nbsp;Amy Fiedler ,&nbsp;Jason Smith ,&nbsp;Liviu Klein","doi":"10.1016/j.jhlto.2025.100464","DOIUrl":"10.1016/j.jhlto.2025.100464","url":null,"abstract":"<div><h3>Background</h3><div>Outflow graft obstruction (OGO) is a rare but potentially fatal complication of left ventricular assist device (LVAD) therapy. Timely diagnosis and intervention are critical to prevent hemodynamic compromise and death.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 191 LVAD patients treated between January 2016 and April 2025. Seven (3.66%) had imaging-confirmed OGO. One died before intervention; 6 underwent intravascular ultrasound (IVUS)-guided stenting. LVAD flows, pressure gradient, and 12-month survival were analyzed.</div></div><div><h3>Results</h3><div>Patients had a mean age of 59.0 ± 13.8 years with a mean LVAD support duration of 63.6 ± 25.3 months. After stenting, mean LVAD flow improved from 1.98 to 4.70 L/min (<em>p</em> = 0.006), while gradients decreased from 74.67 to 31.67 mmHg (<em>p</em> = 0.027). No major complications occurred; all were discharged on warfarin and clopidogrel. The 12-month survival was 83.3% with 2 hemorrhagic strokes.</div></div><div><h3>Conclusion</h3><div>Intravascular ultrasound-guided stenting of OGO is safe and effective. Timely intervention may improve survival. Further research is needed for optimal antiplatelet strategies in LVAD patients undergoing stenting for OGO.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100464"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839591","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":"Waitlist outcome differences for pulmonary hypertension patients are worse in the CAS era","authors":"Mark A. Sonnick MD ,&nbsp;Kemarut C. Laothamatas MD ,&nbsp;Michaela R. Anderson MD, MS ,&nbsp;Darren Stewart MS ,&nbsp;Jake G. Natalini MD, MS ,&nbsp;Selim M. Arcasoy MD, MPH ,&nbsp;Luke Benvenuto MD","doi":"10.1016/j.jhlto.2025.100443","DOIUrl":"10.1016/j.jhlto.2025.100443","url":null,"abstract":"<div><h3>Background</h3><div>Patients with pulmonary hypertension (PH) have previously experienced worse waitlist outcomes than peers with other diagnoses. In 2021, the Lung Allocation Score (LAS) was revised to improve the prediction of expected survival. The Composite Allocation Score (CAS) was subsequently implemented in 2023. The effects of these changes on waitlist outcomes for patients with PH are not known.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the United Network for Organ Sharing database was performed in 3 eras: LAS Era 1 (November 24, 2017-September 30, 2021), LAS Era 2 (October 1, 2021-March 8, 2023), and CAS Era (March 9, 2023-June 27, 2024). Unadjusted and adjusted competing risks regression analyzed waitlist outcomes within each era comparing diagnosis groups, and for PH patients across eras.</div></div><div><h3>Results</h3><div>Adjusted waitlist mortality for PH patients was worse relative to chronic obstructive pulmonary disease (COPD) and cystic fibrosis in LAS Era 1, not significantly different from other groups in LAS Era 2, and worse relative to COPD and interstitial lung disease in the CAS Era. Waitlist mortality for PH patients was unchanged between the LAS Eras and the CAS Era. Transplantation rate for PH patients was improved in the CAS Era compared to LAS Era 2, when measures of right heart dysfunction were removed from the LAS calculations, but not compared to LAS Era 1.</div></div><div><h3>Conclusion</h3><div>In the CAS Era, PH patients continue to experience increased waitlist mortality relative to non-PH diagnoses. Waitlist mortality for PH patients has not improved in the CAS Era compared to the LAS Eras.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100443"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736371","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":"Experience with isavuconazole in lung transplant recipients with Aspergillus isolation in respiratory tract specimens: A multicenter, observational study","authors":"Jose Tiago Silva ,&nbsp;Francisco López-Medrano ,&nbsp;Alicia de Pablo ,&nbsp;Andrea Gutiérrez-Villanueva ,&nbsp;Ana Fernández-Cruz ,&nbsp;Ángela Cano ,&nbsp;Elisa Ruiz-Arabi ,&nbsp;Julián Torre-Cisneros ,&nbsp;Arnau Monforte ,&nbsp;Cristina Berastegui ,&nbsp;Oscar Len ,&nbsp;David Brandariz-Núñez ,&nbsp;Dolores Sousa-Regueiro ,&nbsp;Myrian Aguilar-Pérez ,&nbsp;Mario Fernández-Ruiz ,&nbsp;José Maria Aguado","doi":"10.1016/j.jhlto.2025.100419","DOIUrl":"10.1016/j.jhlto.2025.100419","url":null,"abstract":"<div><h3>Background</h3><div><em>Aspergillus</em> is a life-threatening opportunistic pathogen in lung transplant recipients (LuTRs). Isavuconazole (ISA) is a broad-spectrum triazole with favorable pharmacokinetics and safety profile. The clinical experience with ISA in LuTRs, however, is still limited.</div></div><div><h3>Methods</h3><div>We performed an ambispective observational study from June 2019 to June 2024 in 5 Spanish centers. Adult LuTRs with isolation of <em>Aspergillus</em> spp. in respiratory tract specimens and indication of ISA therapy (either for the treatment of invasive pulmonary aspergillosis [IPA] or tracheobronchial aspergillosis [TBA] or for preemptive therapy) were eligible. The safety outcome comprised the occurrence of treatment-emergent adverse events (trAEs) and the need for modification of tacrolimus dose. Effectiveness outcomes included clinical, mycological, and radiological response at the end of treatment (EoT).</div></div><div><h3>Results</h3><div>Overall, 50 LuTRs were included. ISA was administered for a median duration of 101 days (interquartile range: 27-161) for the treatment of IPA (18 [36.0%]) or TBA (27 [54.0%]) and as preemptive therapy (5 [10.0%]). The incidence rates of any trAE and trAE requiring premature ISA discontinuation were 24.0% and 10.0%, respectively. Most patients (35 [70.0%]) completed the planned course of therapy. Tacrolimus daily dose was reduced by a median of one-third in half of the patients (26/48 [54.2%]). Clinical, mycological, and radiological responses at EoT among were achieved in 66.7%, 84.2%, and 64.3% of evaluable patients, respectively. Aspergillosis-attributable mortality at the end of follow-up was 12.0%.</div></div><div><h3>Conclusions</h3><div>ISA was well tolerated in LuTRs and proved to be effective for the treatment of invasive <em>Aspergillus</em> syndromes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100419"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571804","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":"Tuberculosis in lung and heart transplant recipients","authors":"María Asunción Pérez-Jacoiste Asín PhD ,&nbsp;Francisco López-Medrano PhD ,&nbsp;José María Aguado PhD","doi":"10.1016/j.jhlto.2025.100398","DOIUrl":"10.1016/j.jhlto.2025.100398","url":null,"abstract":"<div><div><em>Mycobacterium tuberculosis</em> is a significant opportunistic pathogen in solid organ transplant recipients, primarily due to the chronic immunosuppression required to prevent graft rejection. Lung and heart transplant recipients are particularly susceptible to tuberculosis (TB) reactivation, as they often undergo more intensive and prolonged immunosuppressive regimens compared to recipients of other organ transplants with lower immunogenicity. Additionally, the risk of donor-derived TB is notably higher in lung transplantation, underscoring the critical importance of thorough TB screening for both donors and recipients. Implementing appropriate treatment protocols based on screening results is essential to prevent the development of TB disease, which can adversely affect the recipient's prognosis. Diagnosing TB in solid organ transplant recipients presents unique challenges. Immunosuppression can attenuate typical inflammatory responses, leading to atypical or absent symptoms. Moreover, there is a higher incidence of extrapulmonary and disseminated TB in this population, which can result in diagnostic delays. Treatment complexities arise from significant drug interactions, particularly between rifampicin and immunosuppressive agents. Furthermore, there is a lack of high-quality studies evaluating the efficacy of rifampin-free regimens and newer drugs for treating multidrug-resistant TB in transplant recipients. This review focuses on TB in the context of lung and heart transplantation, emphasizing the necessity of pretransplant TB infection screening for both donors and recipients, as well as the management strategies for TB disease following transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100398"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521155","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 anastomotic infection after lung transplantation – An interdisciplinary review","authors":"Etienne Abdelnour-Berchtold MD ,&nbsp;Pieter-Jan Gijs MD ,&nbsp;Angela Koutsokera MD ,&nbsp;Laura N. Walti MD","doi":"10.1016/j.jhlto.2025.100417","DOIUrl":"10.1016/j.jhlto.2025.100417","url":null,"abstract":"<div><div>Airway complications (AC) are an important cause of morbidity and mortality post-lung transplantation (LTx). Bronchial anastomotic infection (BAI) is a complication as well as a risk factor for progressive AC post-lung transplantation. The two are closely related and difficult to untangle. AC affects approximately one in ten LTx-recipients, while BAI is reported in around one in thirty LTx-recipients. Associated bacterial pathogens frequently include <em>Pseudomonas aeruginosa</em> and other gram-negative pathogens, while the most frequent reported fungal pathogen is <em>Aspergillus spp.</em>. Associated complication rates are reported to be high. Although the epidemiology and outcome of AC have been investigated, there is an important lack of BAI-specific literature. The incidence, risk factors, treatment and prevention of BAI are not well known. To close this knowledge gap and to ultimately improve prevention, management and outcome; interdisciplinary investigations and prospective studies are warranted.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100417"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521150","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":"An international perspective on allocation rules for combined heart-lung transplantation","authors":"A.M. Holm MD, PhD ,&nbsp;I. Bello MD, PhD ,&nbsp;A. Sandiumenge MD, PhD ,&nbsp;G. Snell MBBS, FRACP, MD ,&nbsp;J. Gottlieb","doi":"10.1016/j.jhlto.2025.100475","DOIUrl":"10.1016/j.jhlto.2025.100475","url":null,"abstract":"<div><div>While the global numbers of lung transplants have increased, the annual numbers of heart-lung transplants have steadily declined over the last decades, combined transplants globally being only about 2% of heart or lung transplant numbers. Although patients eligible for a combined heart-lung transplant may be sicker than those that may be treated with lung transplant only, the increased resource requirement and the dwindling surgical proficiency may have contributed to the declining number of procedures performed. The priority granted to patients requiring a combined transplant in the different organ allocation systems throughout the world vary. In some areas, the candidates for combined transplants compete with urgently ill heart transplant candidates; in others they compete with the lung transplant candidates, and in some there are no defined rules to prioritize those needing a combined heart-lung transplant. The ethical, legal, and practical justifications for the system chosen is often not explicit.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100475"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026157","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":"Heart failure in congenital heart disease—How to manage the Fontan patient","authors":"Jinal Gada MD,&nbsp;Daphne T. Hsu MD","doi":"10.1016/j.jhlto.2025.100426","DOIUrl":"10.1016/j.jhlto.2025.100426","url":null,"abstract":"<div><div>Medical and surgical advances have resulted in excellent midterm survival following the Fontan procedure; however, heart failure has become an important cause of morbidity and mortality as these patients age. The mechanisms of heart failure are multifactorial and include morphologic abnormalities, chronic exposure of the myocardium and pulmonary vascular bed to cyanosis, pathophysiologic volume- and pressure-loads, and myocardial ischemia. Heart failure following the Fontan can be the result of systolic or diastolic ventricular function; equally important is low flow through the Fontan circuit due to abnormalities of the lymphatic or pulmonary vasculature. The hallmarks of a “failing Fontan” circulation include systemic venous congestion and low cardiac output from an underfilled ventricle. Clinical evaluation of the Fontan patient includes evaluation for signs and symptoms of low output and venous congestion along with noninvasive and invasive assessments of hemodynamics and anatomy. Noncardiac comorbidities are common, and laboratory testing is essential for risk stratification. Treatment of heart failure begins with preventive measures to minimize myocardial damage and pulmonary hypertension. Evidence-based medical therapies are lacking, and treatment of ventricular dysfunction is largely limited to Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Effective interventions to decrease the consequences of venous congestion have not been identified. Increasing use of ventricular assist devices has been reported, and heart transplantation remains the intervention of choice for end-stage heart failure. Significant knowledge gaps exist regarding the mechanisms of heart failure, the effectiveness and safety of heart failure medications, and the optimal timing and management of ventricular assist devices and heart transplants.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100426"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076769","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":"Primary graft dysfunction in donor after brain death vs normothermic regional perfusion heart transplants","authors":"Melissa Vu Maffei,&nbsp;Jade M. Kozuch,&nbsp;Mark Mariski,&nbsp;Megan Philbrick,&nbsp;Amanda Topik,&nbsp;Fadi Azar,&nbsp;Justin Cole,&nbsp;Marcus A. Urey,&nbsp;Victor Pretorius,&nbsp;Mark J. Kearns,&nbsp;Kimberly N. Hong","doi":"10.1016/j.jhlto.2025.100439","DOIUrl":"10.1016/j.jhlto.2025.100439","url":null,"abstract":"<div><h3>Background</h3><div>Primary graft dysfunction (PGD) is a leading cause of death within 30 days of heart transplant (HT). Advancements in procurement in donors after circulatory death (DCD), including normothermic regional perfusion (NRP), have led to increased utilization. The purpose of this study was to assess incidence and risk factors for PGD in a modern cohort of HTs who received donors after brain death (DBD) vs DCD allografts procured using NRP.</div></div><div><h3>Methods</h3><div>Retrospective cohort analysis of adult, heart-only transplants at a single center from 1/1/21 to 6/30/23. Modified ISHLT 2014 Consensus Criteria for PGD were used. Risk factors were assessed in univariable analyses and multivariable logistic regression.</div></div><div><h3>Results</h3><div>172 patients met inclusion criteria; 100 DBD, 72 NRP. The DBD arm had higher rates of inotrope dependence and mechanical circulatory support (MCS) pre-transplant; the NRP arm had longer total ischemic time and MCS duration pre-transplant. Incidence of PGD was non-significantly higher in the NRP arm (22% vs 13%, <em>p</em> = 0.11). In the multivariable model, NRP was associated with significantly higher risk of PGD (OR 2.88, 95% CI 1.15-7.20, <em>p</em> = 0.02). PGD patients had longer intensive care unit (ICU) stays, post-transplant inotrope duration, and higher rates of renal replacement therapy. Post-transplant mortality and cardiac function were not significantly different.</div></div><div><h3>Conclusion</h3><div>After adjustment for demographics and clinical characteristics, NRP was associated with higher risk of PGD vs DBD. While index hospitalization resource utilization was increased for PGD patients, midterm outcomes were not different. Further studies are warranted to understand characteristics of NRP that may be associated with increased PGD risk and the clinical significance of PGD post-NRP.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100439"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736374","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":"Exploring patient preferences regarding the use of combination therapy with endothelin receptor antagonist (ERA) + phosphodiesterase-5 inhibitors (PDE5i)","authors":"Nicholas A. Kolaitis MD, MAS ,&nbsp;Martha Kingman DNP ,&nbsp;Melisa Wilson DNP ,&nbsp;Gabriela Gomez Rendon MD ,&nbsp;David Lopez PhD ,&nbsp;Carly J. Paoli PharmD ,&nbsp;Mohammad Rahman PhD ,&nbsp;Ashley Martin PhD ,&nbsp;November McGarvey PhD ,&nbsp;Abraham Lee MS ,&nbsp;Sana Mirza MPH ,&nbsp;Lana Melendres-Groves MD","doi":"10.1016/j.jhlto.2025.100410","DOIUrl":"10.1016/j.jhlto.2025.100410","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate patient preferences for endothelin receptor antagonist (ERA) + phosphodiesterase-5 inhibitor (PDE5i) combination therapies in managing pulmonary arterial hypertension (PAH), including the potential benefits of a single tablet combination therapy (STCT) in reducing pill burden and improving adherence.</div></div><div><h3>Methods</h3><div>An online survey was administered to 201 adult patients with PAH residing in the United States. Patients' preferences toward oral PAH therapies, including willingness to use double combination ERA+PDE5i therapy, were assessed using a discrete choice experiment (DCE).</div></div><div><h3>Results</h3><div>Respondents were predominantly White (86.1%) and female (88.6%), with a median age of 59 years. Most were not employed (56.2%), and 38.3% reported a disability. At the time of the survey, 36.8% were on triple therapy (PDE5i + ERA + prostacyclin), 17.9% on dual therapy (PDE5i + ERA), and the remaining on other or no therapy. Out-of-pocket costs and dosing regimen were the top factors influencing therapy choice in the DCE, with patients preferring lower out-of-pocket costs and simpler dosing regimens. Regarding STCT, 83.1% believed it would reduce pill consumption, 68.7% thought it would decrease time spent managing prescriptions, and 34.8% and 39.3% anticipated improvements in treatment initiation and adherence, respectively.</div></div><div><h3>Conclusions</h3><div>STCT offers potential benefits in reducing pill burden, improving convenience, and possibly facilitating treatment initiation and adherence. However, cost remains a significant factor influencing patient decision-making in PAH therapy in the United States. Addressing cost concerns may increase the acceptance of ERA + PDE5i therapies and STCT among patients with PAH.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100410"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145442676","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}