Journal of Heart and Lung Transplantation最新文献

{"title":"Hemodynamic, echocardiographic, and demographic profiles of patients with chronic thromboembolic pulmonary hypertension and atrial fibrillation: A multicenter cohort study.","authors":"Marta Braksator, Marcin Kurzyna, Grzegorz Kopeć, Piotr Pruszczyk, Ewa Mroczek, Tatiana Mularek-Kubzdela, Ilona Skoczylas, Piotr Błaszczak, Łukasz Chrzanowski, Miłosz Jaguszewski, Katarzyna Mizia-Stec, Zbigniew Gąsior, Grzegorz Grześk, Wojciech Jacheć, Ewa Lewicka, Katarzyna Ptaszyńska-Kopczyńska, Michał Tomaszewski, Ewa Malinowska, Szymon Darocha, Marcin Waligóra, Magdalena Jachymek, Maciej Lewandowski, Małgorzata Peregud-Pogorzelska","doi":"10.1016/j.healun.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.healun.2025.03.020","url":null,"abstract":"<p><strong>Objective: </strong>Atrial fibrillation (AFib) reduces the quality of life and increases hospitalization frequency in patients with pulmonary hypertension (PH). Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of PH with a specific pathophysiology, treatment methods, and demographics; however, the factors that correlate with AFib in this population have not yet been determined. This study aimed to investigate the variables that influence the AFib development in patients with CTEPH and assess the impact of arrhythmia on the mortality rate in this population.</p><p><strong>Design: </strong>Data were obtained from the Database of Pulmonary Hypertension in the Polish Population (NCT03959748), a registry containing data on patients with pulmonary arterial hypertension and CTEPH who were diagnosed and treated in all Polish PH Centers.</p><p><strong>Participants: </strong>This study included 784 adult patients diagnosed with CTEPH.</p><p><strong>Exposure: </strong>We compared echocardiographic, hemodynamic, and demographic variables between patients with and without AFib during database enrollment (retrospective arm) and with and without AFib diagnosis during follow-up (prospective arm).</p><p><strong>Results: </strong>A total of 106 patients (13,5%) with CTEPH were already diagnosed with AFib at enrollment to the registry. We observed a higher incidence of arterial hypertension and chronic renal disease in the arrhythmia than in the non-arrhythmia group. According to the logistic regression analysis, the independent risk factors for AFib development were only pulmonary artery wedge pressure (PAWP, odds ratio [OR] 1,27 per mmHg, 95% confidence interval [CI] 1,082-1,497, p=0,004) and Left Atrial Area (LA area, OR 1,279, 95% CI 1,109-1,476, p=0,001). AFib is associated with higher serum N-terminal prohormone of natriuretic peptide (NTproBNP) levels and is not an independent predictor of mortality.</p><p><strong>Conclusions: </strong>AFib in patients with CTEPH is related to comorbidities similar to those in the general population. The independent predictors of arrhythmia occurrence are PAWP and LA area, suggesting dominant role of left heart disease in AFib development. Atrial fibrillation does not remain an independent predictor of mortality in patients with CTEPH but is associated with increased NTproBNP serum levels.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TELEHEALTH INTERVENTIONS TO IMPROVE OUTCOMES IN LUNG TRANSPLANT RECIPIENTS: Primary Results of the INSPIRE III Randomized Clinical Trial.","authors":"James A Blumenthal, Stephanie Mabe, David Arthur, Courtney Frankel, Daphne C McKee, Samantha Morrison, Andrew Sherwood, Laurie D Snyder, Scott M Palmer","doi":"10.1016/j.healun.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.healun.2025.03.017","url":null,"abstract":"<p><strong>Background: </strong>There is growing evidence that many patients undergoing lung transplantation report significant distress and low physical activity (PA), which might not improve despite lung transplantation and may be associated with worse clinical outcomes. Few studies have attempted to improve psychological outcomes and functional capacity and PA after transplant.</p><p><strong>Methods: </strong>INSPIRE-III is a single-site, randomized clinical trial in which 180 post-lung transplant patients, recruited between November 2019 and October 2023, completed a psychometric test battery to assess distress and functional capacity measured by the Six-Minute Walk Test and PA assessed by 7 consecutive days of continuous activity monitoring. Participants were then were randomly assigned to either a 12-week Coping Skills Training and Exercise intervention (CSTEX) or a Standard of Care and Education (SoC-ED) program delivered via telephone. Participants were then retested after completion of the telehealth interventions.</p><p><strong>Results: </strong>After 12 weeks, both intervention groups achieved small but similar improvements in distress and functional capacity. Although there were no between group differences overall, patients who were considered clinically depressed at baseline and received CSTEX achieved greater improvements in depression compared to depressed patients who received SoC-ED.</p><p><strong>Conclusions: </strong>Although patients in both CSTEX and SoC-ED showed only modest benefit from their respective interventions, a subgroup of patients in CSTEX who were depressed at study entry had greater reductions in depressive symptoms compared to SoC-ED. Depressive symptoms should be carefully monitored post-transplant and referred for treatment if symptoms persist.</p><p><strong>Trial registry: </strong>NCT04093869.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The United Kingdom's experience of controlled donation after circulatory death direct procurement of lungs with concomitant abdominal normothermic regional perfusion with an analysis of short-term outcomes.","authors":"Luke John Lloyd Williams, Rachel Hogg, Miguel Angel Reyes Roque, Sarah Beale, Mubassher Husain, Anand Jothidasan, Pradeep Kaul, Steven Tsui, Hassiba Smail, Ahmed Al Adhami, Jasvir Parmar, Stephen Pettit, Sri Aurovind Periasamy, Prashant Mohite, Philip Curry, Simon Messer, Karim Morcos, Rajamiyer Venkateswaran, Vipin Mehta, Vamsidhar Dronavalli, B C Ramesh, Aaron Ranasinghe, David Quinn, Binu Raj, Ruth Sutcliffe, Dharmic Suresh, Chris Johnston, Gavin Pettigrew, Andrew Butler, Anne Olland, Gillian Hardman, Christopher Watson, Derek Manas, Ian Currie, Marius Berman","doi":"10.1016/j.healun.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.healun.2025.03.019","url":null,"abstract":"<p><strong>Background: </strong>Abdominal Normothermic Regional Perfusion (A-NRP) improves outcomes for transplanted abdominal organs from Donation after Circulatory Death (DCD) donors. Concerns have been raised about the effect of A-NRP on lungs procured during multi-organ donation. We present the UK experience of performing direct procurement (DRP) of lungs from DCD donors with A-NRP.</p><p><strong>Methods: </strong>Retrospective analysis of all 487 UK DCD lung donors between 1 April 2011 and 31 December 2023. Organ transplantation rate and30-day, 90-day and 1-year survival rates were compared between DRP of DCD lungs, DRP of DCD lungs with A-NRP and DBD lungs. PGD rates were compared between DCD lungs with and without A-NRP.</p><p><strong>Results: </strong>Three hundred ninety-seven DCD donors resulted in a lung transplant (22 retrieved by DRP with A-NRP). There was no difference in lung transplantation rates between DRP and DRP with A-NRP. Of the 390 first adult-only lung transplants performed from DCD donors, there was no significant difference in 30-day, 90-day and 1-year survival between DRP of DCD lungs and DRP with A-NRP. There was a significant difference in survival between standard DCD donors and DBD donors at 30-days and 90-days, but not 1 year. There was no significant difference in grade 3 PGD rates at 72 hours post-implantation for DCD lungs with or without A-NRP.</p><p><strong>Conclusion: </strong>In the UK experience, use of A-NRP is not detrimental to procurement of DCD lungs. We advocate the use of this technique until further studies can explore the safety and efficacy of thoraco-abdominal NRP for lungs in multi-organ retrieval.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preconditioning Donor Lungs with Lung-Derived Exosomes Mitigates Ischemia-Reperfusion Injury in a Warm Ischemia Porcine DCD Model.","authors":"Rafaela V P Ribeiro, Salah E Altarabsheh, Daemiel L Segamanasinghe, Ismar W Lopez-Muralles, Ana S Garcia Moreno, Gustavo Knop, Fuad Al-Azzam, Jorge Mallea, Douglas G Brownfield, Aaron C Olson, Daniel F Gibbard, Yujia Jing, Ke Cheng, Sahar A Saddoughi","doi":"10.1016/j.healun.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.healun.2025.03.018","url":null,"abstract":"<p><strong>Background: </strong>Donation after circulatory death (DCD) donors remains an underutilized source in the U.S due to concerns of ischemia-reperfusion injury (IRI) after prolonged ischemic times. Lung-derived exosomes have shown potential in mitigating pulmonary fibrosis by promoting lung repair. Here, we sought to investigate the potential of lung-derived exosomes to prevent and repair lung IRI.</p><p><strong>Methods: </strong>We used a porcine DCD model to induce lung injury. Following the determination of optimal warm ischemic time (WIT), donor pigs were allocated into three study groups (n=5, each): control, pre-DCD exosome treatment, and post-DCD exosomes treatment. Lungs were assessed using ex-vivo lung perfusion (EVLP) for functional parameters, histological evaluation, and molecular analysis of inflammatory markers and oxidative stress.</p><p><strong>Results: </strong>A 1-hour WIT induced consistent lung injury, which was ameliorated with pre-DCD exosome treatment exhibiting significantly improved lung function during EVLP compared to controls. This group presented higher pO2, better lung compliance, lower airway pressures, and reduced pulmonary vascular resistance. Histological analysis indicated reduced edema, vascular congestion, and leukocyte infiltration. Key inflammatory cytokines such as IL-6, IL-1β, TNF-α were significantly downregulated, and reactive oxygen species (ROS) levels were lower than controls. Despite inferior response compared to pre-DCD treatment, post-DCD exosomes treatment also improved lung function and reduced edema formation, with significant decrease in TNF-α expression.</p><p><strong>Conclusions: </strong>Lung-derived exosome therapy significantly mitigates IRI in a porcine DCD model, improving lung function and reducing inflammation and oxidative stress. These findings support the potential of exosome therapy to increase donor lung utilization, warranting further mechanistic and clinical studies.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"UNLOCKING THE BLACK BOX OF HEART PRESERVATION.","authors":"A Aliabadi-Zuckermann, A Zuckermann","doi":"10.1016/j.healun.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.healun.2025.03.012","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the prognostic value of right atrial echocardiographic parameters in pulmonary arterial hypertension.","authors":"Danny Mohama, Pitchaya Worapongsatitaya, Bettia Celestin, Felipe Kazmirczak, Shadi P Bagherzadeh, Kurt W Prins, Sasha Z Prisco, E Kenneth Weir, Roham Zamanian, Francois Haddad, Thenappan Thenappan","doi":"10.1016/j.healun.2025.03.009","DOIUrl":"10.1016/j.healun.2025.03.009","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) guidelines advocate measures of area for right atrial (RA) dimensions, while echocardiographic guidelines recommend RA volume. We compared the prognostic value of RA echocardiographic parameters to predict transplant-free survival in 332 adult patients with PAH. RA area correlated strongly with volume (r = 0.96). After adjusting for age and sex, for every 1-standardized unit increase in RA area index, volume index, and major axis dimension, there were 21%, 18%, and 18% higher hazards of mortality or transplant, respectively. However, no RA parameter was independently associated with transplant-free survival when adjusted for Registry to Evaluate Early and Long-Term PAH Disease Management lite score. RA area index had the highest area under the curve for predicting transplant-free survival.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How relevant is xenogeneic cross-circulation as a model to repair human donor organs?","authors":"Yajin Zhao, Mingyao Liu","doi":"10.1016/j.healun.2025.03.014","DOIUrl":"10.1016/j.healun.2025.03.014","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Primary Graft Dysfunction of the Transplanted Heart - More Than a Single Category?","authors":"Eleni Tseliou, Josef Stehlik","doi":"10.1016/j.healun.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.healun.2025.03.002","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung rehabilitation using xenogeneic cross-circulation does not lead to hyperacute rejection in a human lung transplantation model.","authors":"Kaitlyn M Tracy, Timothy R Harris, Mark Petrovic, Michael Cortelli, William Tucker, Sean François, Yutaka Shishido, Victoria Simon, Brandon Petree, Carl A Johnson, Wei K Wu, Nancy L Cardwell, Elizabeth Simonds, TiOluwanimi T Adesanya, Avery K Fortier, Kimya Raietparvar, Stuart R Landstreet, Nancy Wickersham, John D O'Neill, John Poland, Ashish S Shah, Stephen DeVries, Christian Crannell, Charles C Marboe, Rei Ukita, Caitlin T Demarest, Ciara M Shaver, Matthew Bacchetta","doi":"10.1016/j.healun.2025.02.1696","DOIUrl":"https://doi.org/10.1016/j.healun.2025.02.1696","url":null,"abstract":"<p><strong>Background: </strong>Access to life-saving lung transplantation remains limited by a shortage of donor organs. We have previously described rehabilitation of discarded human donor lungs to a quality suitable for transplantation using cross-circulation of whole blood between xeno-support swine and human lungs. However, the immunologic implications of transplanting rehabilitated lungs remain unknown.</p><p><strong>Methods: </strong>Human donor lungs declined for clinical transplantation (N=5) underwent xenogeneic cross-circulation for up to 12 hours. To model subsequent human transplantation, lungs were re-exposed to autologous human whole blood via normothermic ex vivo machine perfusion for up to six hours. Upon human blood re-exposure, lungs were evaluated for evidence of hyperacute rejection through physiologic assessments and tissue analyses including histology, immunostaining, and flow cytometry.</p><p><strong>Results: </strong>Upon human blood re-exposure, lungs showed no significant change in physiologic function relative to end of cross-circulation (PaO₂/FiO₂: P=0.41; vascular resistance: P=0.27; dynamic compliance: P=0.24) and histologic features of hyperacute rejection were absent in all lungs. Despite pulmonary deposition of porcine IgG during cross-circulation, human blood re-exposure resulted in decreased complement deposition (P=0.019) with no change in membrane attack complex formation (P=0.65) or apoptotic signaling (P=0.93). Endothelial integrity was maintained after human blood re-exposure with preservation of microvascular tight junctions, decreasing endothelial injury marker P-selectin (P=0.34), and intact vascular response to alpha adrenergic stimulation.</p><p><strong>Conclusions: </strong>Our findings indicate that transient exposure of human donor lungs to xenogeneic cross-circulation does not result in hyperacute rejection upon simulated human transplantation, representing an important step towards clinical translation of this donor organ rehabilitation platform.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular criteria for pulmonary antibody-mediated rejection are associated with an increased risk of allograft failure.","authors":"Michael B Keller, David Newman, Muhtadi Alnababteh, Ann Bon, Lucia Ponor, Pali Shah, Joby Matthews, Hyesik Kong, Temesgen Andargie, Woojin Park, Ananth Charya, Helen Luikart, Tyler Intrieri, Shambhu Aryal, Steven D Nathan, Jonathan B Orens, Kiran K Khush, Moon Jang, Sean Agbor-Enoh","doi":"10.1016/j.healun.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.healun.2025.03.015","url":null,"abstract":"<p><strong>Background: </strong>Current International Society for Heart and Lung Transplantation (ISHLT) criteria for pulmonary antibody-mediated rejection (AMR) is predicated on a constellation of clinical, laboratory and histopathological parameters, including the presence of donor-specific antibodies (DSA). However, molecular evidence of allograft injury is not considered. The aim of this study was to investigate if allograft injury on the molecular level, as measured by donor-derived cell-free DNA (dd-cfDNA), identifies DSA positive patients experiencing a form of AMR associated with increased risk of chronic lung allograft dysfunction (CLAD) or death.</p><p><strong>Methods: </strong>This multicenter, observational analysis included adult lung transplant recipients from two prospective cohort studies. Serial plasma samples were collected for dd-cfDNA measurement by shotgun sequencing. Molecular AMR was defined as the presence of DSA and dd-cfDNA level >1% occurring > 30 days post-transplant. Clinical AMR was defined using ISHLT criteria. Time-dependent multivariable Cox regression models were used to determine the association of Clinical AMR or Molecular AMR with the composite outcome of CLAD or death.</p><p><strong>Results: </strong>The final analysis included 209 subjects. Sixty-one subjects met criteria for molecular AMR. Molecular AMR captured 42/46 (91%) of patients who experienced Clinical AMR. Molecular AMR was associated with an increased risk of CLAD or death (HR 2.00, 95% CI: 1.18 - 3.38, p = 0.010). The results remained consistent analyzing Molecular AMR subjects without concomitant ISHLT Clinical AMR, acute rejection, or infection (HR 2.45, 95% CI: 1.01 - 5.94, p = 0.047).</p><p><strong>Conclusions: </strong>Molecular AMR identifies a population of lung transplant recipients potentially experiencing antibody-mediated rejection not captured by current ISHLT criteria.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}