JHLT Open最新文献

{"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}

{"title":"Challenges in medication titration in children with heart failure","authors":"Jessie Yester MD, PhD,&nbsp;Deipanjan Nandi MD, MSc","doi":"10.1016/j.jhlto.2025.100358","DOIUrl":"10.1016/j.jhlto.2025.100358","url":null,"abstract":"<div><div>The management of pediatric heart failure and titration of oral medical therapies remains in its infancy. Burdened by a lack of understanding of the diverse pediatric heart failure etiologies, limitations in clinical trials, a lack of society guidelines, as well as other health care systemic issues, titration of medications is greatly lacking. We herein review the difficulties with medication titration in pediatric heart failure, and highlight important next steps to remedy the situation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858449","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":"Prognostic value of NT-proBNP monitoring in patients with left ventricular assist devices","authors":"Miloud Cherbi MD ,&nbsp;Joaquim Verdaguer MD ,&nbsp;Romain Itier MD ,&nbsp;Laurence Barde MD ,&nbsp;Pauline Fournier MD ,&nbsp;Etienne Grunenwald MD ,&nbsp;Philippe Gaudard MD, PhD ,&nbsp;Philippe Rouvière MD ,&nbsp;Adrien Molina MD ,&nbsp;Aurore Ughetto MD ,&nbsp;Clément Delmas MD, PhD","doi":"10.1016/j.jhlto.2025.100387","DOIUrl":"10.1016/j.jhlto.2025.100387","url":null,"abstract":"<div><h3>Background</h3><div>N-terminal fragment of the brain natriuretic peptide (NT-proBNP) is a well-established biomarker in heart failure; however, its prognostic value in patients supported by left ventricular assist devices (LVAD) remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including patients implanted with an LVAD between 2008 and 2025 at 2 tertiary care centers. NT-proBNP levels were measured at 3 and 6 months postimplantation, and their relationships with invasive hemodynamic parameters and 1-year clinical outcomes were evaluated at each time point.</div></div><div><h3>Results</h3><div>A total of 128 patients were included. Whereas NT-proBNP measured at 3 months showed no significant correlation with any hemodynamic parameters, NT-proBNP at 6 months correlated with right atrial pressure (ρ = 0.46, <em>p</em> &lt; 0.01), systolic pulmonary artery pressure (ρ = 0.39, <em>p</em> = 0.03), and pulmonary capillary wedge pressure (ρ = 0.39, <em>p</em> = 0.02). NT-proBNP measured at 3 months was not significantly associated with 1-year mortality, pump thrombosis, or right ventricular (RV) failure. Conversely, NT-proBNP at 6 months was independently associated with an increased risk of the composite end-point of mortality or pump thrombosis (adjusted hazard ratio 1.34 [1.07-1.62] per 500 pg/ml increase), and the composite end-point of mortality or RV failure (adjusted odds ratio 1.53 [1.17-2.01] per 500 pg/ml increase).</div></div><div><h3>Conclusions</h3><div>NT-proBNP measured at 6 months post-LVAD implantation is a significant predictor of adverse clinical and hemodynamic outcomes at 1 year, supporting its role in risk stratification. Prospective studies are warranted to validate these findings.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100387"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265874","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":"Pediatric heart transplant survival in single ventricle disease","authors":"Jillian Wen MD,&nbsp;Marc Richmond MD, MS","doi":"10.1016/j.jhlto.2025.100396","DOIUrl":"10.1016/j.jhlto.2025.100396","url":null,"abstract":"<div><div>Outcomes in pediatric heart transplantation have steadily improved since the first pediatric heart transplant was performed by Dr. Kantrowitz and his team in 1967; however, there is still progress to be made. Patients with congenital heart diseases (CHD) consistently have worse waitlist mortality, post-transplant survival, infection rates, and post-transplant lymphoproliferative disease (PTLD) risk, with single ventricle disease (SVD) patients being at particularly high risk for rejection and rejection with severe hemodynamic compromise (RSHC). Furthermore, there has been little improvement in the development of cardiac allograft vasculopathy (CAV) and PTLD over the decades, and survival following diagnosis continues to remain poor for all patients regardless of diagnosis. Hopefully, as new advances in immunosuppression, mechanical support, and surgical techniques emerge, we will continue to develop a deeper understanding of the co-morbidities associated with pediatric heart transplant to further improve the survival and quality of life of pediatric heart transplant recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100396"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323839","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":"Corrigendum to “Outcomes of combined liver-lung transplant in pediatric patients with cystic fibrosis: An ISHLT transplant registry study” [JHLT Open (2025) 100212]","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.2025.100432","DOIUrl":"10.1016/j.jhlto.2025.100432","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100432"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519452","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":"Molecular diagnostics for the monitoring of the cardiac allograft","authors":"Lauren K. Truby MD, MS ,&nbsp;Jeffrey Teuteberg MD","doi":"10.1016/j.jhlto.2025.100354","DOIUrl":"10.1016/j.jhlto.2025.100354","url":null,"abstract":"<div><div>Heart transplantation (HT) remains the optimal long-term therapy to improve survival in eligible patients living with end-stage heart disease. Monitoring the health of the allograft over its lifespan is critical to ensure the rapid diagnosis of immunologic, vascular, and myocardial events to enable the timely deployment of appropriate medical therapies. Advances in next-generation sequencing are being applied to screening for allograft rejection to the early detection of malignancy and have already been integrated into the routine care of HT recipients. Further personalization of care by integrating omics and imaging technologies, combined with novel data analysis methods, is at hand.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100354"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826907","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}