JHLT Open最新文献

{"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":"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}

{"title":"Macitentan and phosphodiesterase-5 inhibitor alone or in combination in newly diagnosed pulmonary arterial hypertension: a pooled analysis","authors":"Vallerie V. McLaughlin MD ,&nbsp;Nicolas Sauvageot PhD ,&nbsp;Brian Hennessy PhD ,&nbsp;Sumeet Panjabi PhD ,&nbsp;Carly J. Paoli PharmD, MPH ,&nbsp;Jörg Linder PhD ,&nbsp;Bjorn Bayer MS ,&nbsp;Stefan Söderberg MD, PhD ,&nbsp;Sean Gaine MD, PhD, FRCPI ,&nbsp;Tobias J. Lange MD ,&nbsp;Nick H. Kim MD","doi":"10.1016/j.jhlto.2025.100462","DOIUrl":"10.1016/j.jhlto.2025.100462","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Upfront combination therapy with endothelin receptor antagonist (ERA) and phosphodiesterase-5 inhibitor (PDE5i) is guideline-recommended for low- or intermediate-risk pulmonary arterial hypertension (PAH). This study compared time to all-cause mortality for macitentan+PDE5i combination and each monotherapy.</div></div><div><h3>METHODS</h3><div>Long-term patient-level data (planned follow-up ≥1 year) were pooled from four clinical trials and three observational registries. All-cause mortality data were available from adults with incident PAH initiated on macitentan 10 mg or PDE5i monotherapy, or macitentan+PDE5i. Propensity-score (PS) methods balanced key demographic and disease characteristics across cohorts. Hazard ratios (HRs) were computed from a Cox-regression model that included PS-calculated weights. Weighted Kaplan–Meier estimates with 95% confidence intervals (CI) were computed 6-monthly.</div></div><div><h3>RESULTS</h3><div>2201 patients were included: 754 received macitentan+PDE5i (421 tadalafil, 324 sildenafil, 9 other), 654 macitentan, and 793 PDE5i (301 tadalafil, 490 sildenafil, 2 other). After weighting, characteristics were similar across cohorts. Upfront macitentan+PDE5i was associated with a 39% risk reduction of all-cause mortality versus PDE5i (HR 0.61 [95% CI 0.46–0.82]) and 32% versus macitentan (HR 0.68 [95% CI 0.37–0.95]). Reduction in all-cause mortality was 49% for macitentan+tadalafil vs tadalafil (HR 0.51 [95% CI 0.30–0.85]), 43% for macitentan+tadalafil vs macitentan (HR 0.57 [95% CI 0.37–0.88]), 31% for macitentan+sildenafil vs sildenafil (HR 0.69 [95% CI 0.45–1.0]) and 26% for macitentan+sildenafil vs macitentan (HR 0.74 [95% CI 0.46–1.17]).</div></div><div><h3>CONCLUSION</h3><div>This large, pooled analysis suggests an observed statistical association indicating a potential survival benefit for early macitentan+PDE5i versus either monotherapy in newly diagnosed PAH.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100462"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924310","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":"Humoral rejection in heart transplantation in the current era","authors":"Jared Sheridan,&nbsp;Simon Urschel","doi":"10.1016/j.jhlto.2025.100427","DOIUrl":"10.1016/j.jhlto.2025.100427","url":null,"abstract":"<div><div>Immune response to the human leukocyte antigens (HLA) of a donor heart, resulting in antibody-mediated rejection (AMR), remains one of the greatest challenges in current transplant medicine. Besides the risk of acute functional deterioration of the graft during rejection, there is clear evidence of induction and acceleration of the development of coronary allograft vasculopathy with recurrent or severe AMR and development of donor–specific HLA antibodies. Management guidelines and consensus statements currently have to rely on limited evidence.</div><div>In this review, we illustrate some of the immune mechanisms underlying AMR, summarize the clinical impact, and discuss the therapy concepts of the recently emerging armamentarium of medical interventions. We also highlight some pitfalls for AMR-therapy protocol design and suggest a staged approach for decision-making at the occurrence of <em>de novo</em> donor-specific antibodies post transplant.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100427"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571792","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":"Causal nonlinear dose response analysis of donor–recipient predicted heart mass ratio","authors":"Reid Dale PhD ,&nbsp;Nataliya Bahatyrevich MD, MS ,&nbsp;Matthew Leipzig BSc ,&nbsp;Katharine Pines MPH ,&nbsp;Maria Currie MD, PhD","doi":"10.1016/j.jhlto.2025.100418","DOIUrl":"10.1016/j.jhlto.2025.100418","url":null,"abstract":"<div><h3>Objective</h3><div>Size-matching in heart transplantation is performed using Predicted Heart Mass (PHM). It is common to regard a Donor-Recipient PHM Ratio smaller than 0.86 to be undersized. Novel applications of nonlinear models to estimate the dose-response effect of heart size mismatching can better calibrate postoperative risk.</div></div><div><h3>Methods</h3><div>Patients receiving an isolated heart transplant ages 18 and older between 2000 and 2022 were included. Donor-Recipient PHM Ratio was continuously weighted using Tübbicke’s entropy balance method. A Cox proportional hazards model was applied to the weighted sample. We fit penalized smoothing splines to estimate the continuous effect size of Donor-Recipient PHM Ratio on survival. Significance of the nonlinear spline terms was assessed and confidence bands for effect size were constructed.</div></div><div><h3>Results</h3><div>A total of 47,942 patients met inclusion criteria. The nonlinear spline terms for Donor-Recipient PHM Ratio were significantly associated with survival (p = 0.004). The effect of Donor-Recipient PHM Ratio was approximately flat between 0.9 and 1.2. Hazard grew approximately linearly below 0.9. At 0.86, the effect was estimated to be HR = 1.05 (95% CI: 1.02, 1.09). At 0.8, the effect was estimated to be HR = 1.13 (95% CI: 1.06, 1.20).</div></div><div><h3>Conclusions</h3><div>Accurately modeling the effect of donor-recipient heart size matching is necessary to inform the decision of whether to accept or reject a donor organ. We found that heart undersizing confers an increased risk of mortality. We fail to find large changes in the slope of the effect at any particular PHM ratio cutoff.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100418"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521153","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":"Differences in mortality by donor sex and age in heart transplantation: An individual patient data meta-analysis","authors":"Rizky I. Sugianto ,&nbsp;Xun Zhang ,&nbsp;Bernd Döhler ,&nbsp;Mourad Dahhou ,&nbsp;Caner Süsal ,&nbsp;Amanda Vinson ,&nbsp;Lauren Grinspan ,&nbsp;Jeannine von der Born ,&nbsp;Hien Tran ,&nbsp;Bethany J. Foster ,&nbsp;Anette Melk","doi":"10.1016/j.jhlto.2025.100466","DOIUrl":"10.1016/j.jhlto.2025.100466","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies suggested a recipient sex-dependent association between donor sex and heart transplant survival. We hypothesized that donor age also modifies the association between donor sex and recipient mortality.</div></div><div><h3>Methods</h3><div>Deceased donor heart transplant recipients (1988-2019, <em>n</em> = 109,432) recorded in the Scientific Registry of Transplant Recipients (SRTR) and the Collaborative Transplant Study (CTS) were analyzed. We used multivariable Cox regression models to estimate the association between donor sex and mortality, accounting for the modifying effects of recipient sex and donor age. Results from cohort-specific models were combined using individual patient data meta-analysis.</div></div><div><h3>Results</h3><div>Among female recipients, mortality was lower with female than male donors across all donor age groups, though differences were not statistically significant. Among male recipients, female donors aged 13-44 years were associated with higher mortality compared with male donors, although the difference was not statistically significant. In sensitivity analyses, aHR comparing mortality associated with female vs male donors were lower after adjusting for donor-recipient heart size mismatch. Female recipients of female donors aged 18-44 years had significantly lower mortality than recipients of same-aged male donors. Among male recipients of donors aged ≥45 years, mortality was significantly lower with a female than a male donor.</div></div><div><h3>Conclusion</h3><div>Donor age modifies the association between donor sex and survival after heart transplantation. When appropriately size-matched, female donors are associated with similar or lower mortality compared with male donors in both female and male recipients, suggesting a potential survival advantage with female donor hearts.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100466"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883690","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 efficacy of biodegradable polymer everolimus-eluting stents in patients with cardiac allograft vasculopathy","authors":"Masaki Tsuji MD, PhD ,&nbsp;Michelle M. Kittleson MD, PhD ,&nbsp;David H. Chang MD ,&nbsp;Evan P. Kransdorf MD, PhD ,&nbsp;Andriana P. Nikolova MD ,&nbsp;Lily K. Stern MD ,&nbsp;Babak Azarbal MD ,&nbsp;Jon A. Kobashigawa MD","doi":"10.1016/j.jhlto.2025.100408","DOIUrl":"10.1016/j.jhlto.2025.100408","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a therapeutic option for cardiac allograft vasculopathy (CAV). Biodegradable polymer (BP)-DES, designed to promote vessel healing and reduce inflammation compared with durable polymer (DP)-DES, has been developed. In this study, we aimed to compare the efficacy of BP-DES and DP-DES in patients with CAV.</div></div><div><h3>Methods</h3><div>In this single-center retrospective study, we evaluated patients with CAV who underwent their first PCI between 2010 and 2024; the patients were categorized into the BP-DES and DP-DES groups. Clinical (all-cause death or heart retransplantation) and angiographic outcomes (in-stent restenosis [ISR], target lesion revascularization [TLR], target vessel revascularization [TVR], target vessel nontarget lesion revascularization [TVNLR], and nontarget vessel revascularization [NTVR]) were assessed.</div></div><div><h3>Results</h3><div>Among 178 patients who underwent PCI, 40, 106, 11 received the BP-DES, DP-DES, and both, respectively. The average age at PCI was 60.3 ± 13.1 years. Survival from all-cause death or heart retransplantation after PCI was similar between the groups (<em>p</em> = 0.093). Of 90 BP-DES implanted, 60 were reassessed during follow-up catheterization, whereas 171 of 221 DP-DES implanted were reassessed. Both groups exhibited similar ISR, TLR, TVR, and NTVR rates; however, the TVNLR rate was significantly lower in the BP-DES group (<em>p</em> = 0.049). BP-DES implantation was an independent protective factor against TVNLR (hazard ratio 0.42, 95% confidence interval 0.20–0.91, <em>p</em> = 0.027).</div></div><div><h3>Conclusions</h3><div>PCI with BP-DES was associated with a lower TVNLR than PCI with DP-DES. Both DES resulted in similar clinical outcomes; however, a long-term investigation is warranted.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100408"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415667","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}