Journal of Heart and Lung Transplantation最新文献

{"title":"Effects of Impella 5.5 on Right Ventricular Load and Adaptation.","authors":"Molly Silkowski, Alexander Olson, Moses Asempah, Anthony Carnicelli, Ryan Tedford, Brian Houston","doi":"10.1016/j.healun.2026.05.001","DOIUrl":"https://doi.org/10.1016/j.healun.2026.05.001","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856447","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 National Programme of DCD Heart Transplantation: Timings, Techniques, Feasibility and Outcomes with Abdominal Normothermic Regional Perfusion.","authors":"Karim Morcos, Lewis Simmonds, Sally Rushton, Rachel Hogg, Simon Messer, Debbie Macklam, Mubbasher Husain, Stephen Large, Steven Tsui, Pradeep Kaul, Hassiba Smail, Prashant Mohite, Sri Aurovind Priasamy, Jennifer Baxter, Jp Nunes, Stephen Pettit, Philip Curry, Hari Doshi, Sukumaran Nair, Mohamed Osman, Aravinda Page, Bart Zych, María Monteagudo-Vela, Aaron Ranasinghe, Majid Mukadam, David Quinn, Vipin Mehta, Vasudev Pai, Derval Russell, Diana Garcia Saez, Rajamiyer Venkateswaran, B C Ramesh, Vamsidhar Dronavalli, Jerome Jungschleger, Louise Kenny, Jacob Simmonds, Guy Macgowan, Zdenka Reinhardt, Jane Speed, Jayan Parameshwar, David Jenkins, Sarah Watson, Fiona Marley, Ayesha Ali, Dale Gardner, Antonio Rubino, Julie Whitney, Catherine Slater, Liz Armstrong, Jeanette Foley, Marian Ryan, Sharon Gibson, Karen Quinn, Anna-Maria Macleod, Susan Spence, Chris Johnston, Andrew Butler, Chris Watson, Anthony Clarkson, Derek Manas, Ian Currie, Mr Marius Berman","doi":"10.1016/j.healun.2026.04.027","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.027","url":null,"abstract":"<p><strong>Background: </strong>The United Kingdom (UK) was one of the first countries to pioneer donation after circulatory death (DCD) heart transplants. To establish equitable access to DCD hearts, a nationally-funded DCD programme was established in 2020. We report the results of this programme and examine retrieval techniques, ischaemic times and survival.</p><p><strong>Methods: </strong>This multi-centre, retrospective, observational study compared DCD versus donation after brain death (DBD) heart transplant outcomes from 2020-2024. DCD hearts were retrieved using direct procurement and perfusion (DPP) with/without abdominal normothermic regional perfusion (A-NRP). Primary outcomes were 1-year survival and severe primary graft dysfunction (PGD). Ischaemic times, cannulation techniques and A-NRP status were analysed.</p><p><strong>Results: </strong>There were 188 DCD and 523 DBD heart transplants. There was no difference in 30-day (96% DCD vs 95% DBD, p=0.76) or 1 year survival (87% DCD vs 88% DBD, p=0.81). There was no difference in severe PGD (unadjusted analysis; 28% DCD vs 24% DBD, p=0.26). DPP with A-NRP increased ischaemic timings (asystole to cardioplegia delivery, 15 mins (n=22; A-NRP/DPP) vs 13 mins (n=166; DPP, p=0.0022). Propensity-matched analysis showed no difference in 90-day survival (86.4% vs 88.6%; p=0.7828). Papworth cannulation technique reduced ischaemic times with no impact on outcomes. Longer implant (p=0.03) and ex-situ perfusion (p=0.02) times were associated with severe PGD/death at 1 year.</p><p><strong>Conclusion: </strong>DCD heart donation increased UK heart transplantation by 36% compared with DBD alone, with results comparable to DBD. A-NRP/DPP is feasible but prolongs ischaemic times, although survival was similar to the DPP group. The main predictors of poor 1-year survival were implant and ex-situ perfusion times.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838873","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":"Response to: \"Early post lung transplant neutrophil dynamics within 72 hours\".","authors":"Rachel Klein, Jonathan Braat, Ashwini Arjuna, Megan Paternoster, Michael Smith, Ross Bremner, Thalachallour Mohanakumar, Davide Scozzi","doi":"10.1016/j.healun.2026.04.024","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.024","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838907","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":"An Integrated Clinical-Histopathologic Prediction Model for Cardiac Allograft Rejection: Translating Machine Learning into Clinical Risk Frameworks.","authors":"Dale D Kim, Anant Madabhushi, Kenneth B Margulies, Eliot G Peyster","doi":"10.1016/j.healun.2026.04.031","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.031","url":null,"abstract":"<p><strong>Background: </strong>Cardiac allograft rejection (CAR) remains the leading cause of early graft failure after heart transplantation (HT). Current diagnostics, including histologic grading of endomyocardial biopsy (EMB) and blood-based assays, lack accurate predictive power for future CAR risk. We developed a predictive model integrating routine clinical data with EMB-derived quantitative morphologic features to demonstrate the precision-medicine potential of mining existing data sources in post-HT care.</p><p><strong>Methods: </strong>In a retrospective cohort of 484 HT recipients with 1,188 EMB encounters within 6 months post-transplant, we extracted 370 quantitative pathology features from digitized H&E-stained slides and 268 longitudinal clinical features from routine lab testing. Trained using the XGBoost algorithm, we compared model performance across time (cross-sectional vs longitudinal) and across data domains (clinical vs morphologic). The top predictors of our best-in-class model informed the derivation of a simplified Integrated Rejection Risk Index (IRRI) for patient risk stratification. Model performance was evaluated by AUROC, AUPRC, and time-to-event hazard ratios.</p><p><strong>Results: </strong>The fully integrated longitudinal model, inclusive of clinical and morphologic domains, achieved superior predictive accuracy (AUROC 0.86, AUPRC 0.74) compared to cross-sectional or single-domain models. IRRI stratified patients into risk categories with distinct future CAR hazards: high-risk patients showed a markedly increased CAR risk (HR=6.15, 95% CI: 4.17-9.09), while low-risk patients had significantly reduced risk (HR=0.52, 95% CI: 0.33-0.84).</p><p><strong>Conclusions: </strong>By integrating longitudinal clinical and biopsy morphologic features, IRRI provides a scalable, interpretable tool for proactive CAR risk assessment. This precision-based approach offers a promising pathway toward risk-adaptive surveillance and immunosuppressive strategies.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816280","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":"Between Withdrawal and Death: Can Machine Learning Improve DCD Utilization?","authors":"Joseph B Lerman, Adam D DeVore","doi":"10.1016/j.healun.2026.04.029","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.029","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816216","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":"DCD Heart Transplantation Across the Atlantic: Diverging Practices, Converging Outcomes.","authors":"Pierre-Emmanuel Noly, Julien Guihaire","doi":"10.1016/j.healun.2026.04.030","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.030","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816311","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":"Editorial Commentary: Bridging Therapy Before Pulmonary Endarterectomy-Reaffirming the Primacy of Early Surgical Referral.","authors":"Raymond Benza","doi":"10.1016/j.healun.2026.04.023","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.023","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816276","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":"Expanding the Donor Pool Further-Rapid Recovery Without Pre-implant Reanimation for Combined Heart-Lung Donation After Circulatory Death Transplantation.","authors":"Amir Teimouri Dereshgi, Kevin McGann, Swaroop Bommareddi, John M Trahanas, Brian Lima, Awab Ahmad, Enock Adjei, Stephen Tapia-Ruano, Caitlin Demarest, John W Stokes, Ashish S Shah, Aaron M Williams","doi":"10.1016/j.healun.2026.04.025","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.025","url":null,"abstract":"<p><p>Donation after circulatory death (DCD) donors have expanded the heart transplant donor pool. Current DCD recovery strategies typically require donor heart reanimation but remain limited by logistical complexity, cost, and ethical concerns. These challenges are further amplified in heart-lung transplantation. Although brain-dead donors (DBD) have historically been the primary source of heart-lung blocs, successful DCD heart-lung transplantation has recently been reported. However, most cases rely on thoracoabdominal normothermic regional perfusion (TA-NRP), which has limited global adoption and raises concerns regarding ethical considerations and lung utilization. Rapid recovery with extended ultra-oxygenation preservation (REUP) has recently emerged as an alternative strategy for DCD heart recovery without pre-implant reanimation. In this report, we describe the first application of the REUP technique in concert with direct lung procurement to recover an en bloc heart-lung, enabling successful combined heart-lung transplantation with excellent early graft function.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816224","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":"Reduced Post-transplant Survival in Patients Bridged with durable LVADs following the 2018 US Heart Allocation Policy Change: OPTN/ UNOS Registry Analysis.","authors":"J Sam Meyer, Arielle Zur, Dan Aravot, Josef Stehlik, Yaron D Barac","doi":"10.1016/j.healun.2026.04.020","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.020","url":null,"abstract":"<p><strong>Purpose: </strong>In 2018, the US implemented heart allocation changes to address evolving trends in waiting list mortality. This study examines the impact of the allocation changes on post-transplant survival in patients bridged with durable left ventricular assist devices (LVAD) compared to non-LVAD heart transplant recipients.</p><p><strong>Methods: </strong>We used the OPTN/UNOS registry to identify adult (≥18 years), first-time, heart-only transplant recipients from 2014-2023. Recipients were categorized by date of transplant into PRE- (1/1/14-17/10/18) and POST (18/10/18-6/10/23) groups and LVAD status at transplant (LVAD vs non-LVAD) to form four analytic groups. Survival outcomes were analyzed using the Kaplan-Meier method. Multivariable Cox regression was used to estimate adjusted associations with post-transplant mortality.</p><p><strong>Results: </strong>A total of 23,221 HT recipients were included: 11,273 in the PRE (3,542 with LVAD and 7,731 without LVAD) and 11,948 in the POST (3,145 with LVAD and 8,803 without LVAD) era. Compared to PRE, the POST patients were younger (53.8, 52.8 vs 54.0, 54.2 years, p < 0.001), and had better renal function (1.2, 1.2 creatinine vs 1.3, 1.3, p < 0.001). The proportion of patients with LVAD at HT decreased from 31.4% in PRE to 26.3% in POST era (p < 0.001). POST mean waiting times were significantly reduced in non-LVAD recipients (251 to 83 days, 67.1% reduction, p < 0.001) and less so in bridged LVAD recipients (259 to 145 days, 44.0% reduction, p < 0.001). In the POST era, the acuity of LVAD candidates at transplant was higher -the proportion of LVAD patients with < 50 % Karnofsky score was 36 % PRE vs 53.7 % POST (p < 0.0001) and the proportion of LVAD patients on inotropes was 8.1% PRE vs 20.6% POST (p < 0.0001). One-year post-transplant survival of patients bridged with LVAD was 91.2% PRE and 89.3% POST, p<0.0001, and this difference increased further at 3 years - 85.10% PRE to 80.0% POST (p < 0.0001, Table 2). Meanwhile, 1-year survival in patients without LVAD was nominally similar PRE and POST - 91.70% vs 92.0% (p < 0.001), and there was a smaller difference at 3-years - 86.2% PRE vs 83.5% POST, p < 0.0001. Multivariable Cox regression showed that post-policy change, LVAD at transplant was independently associated with increased mortality (HR 1.26, 95% CI 1.12-1.43, p < 0.001).</p><p><strong>Conclusions: </strong>The 2018 heart allocation policy revision was effective in improving access to transplant for the most acutely ill patients and reducing waitlist mortality. However, the reduction of wait times was not realized to the same extent in LVAD-bridged patients, who also have a signal for higher post-transplant mortality in the current era. Our data provide insights into approaches that may mitigate this excess risk and ensure equitable outcomes for the increasingly complex population of patients bridged to transplant with durable LVADs.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816231","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":"Therapeutic decisions in chronic thromboembolic pulmonary hypertension pre- and post-intervention should be informed by multimodal risk stratification.","authors":"Paula Appenzeller, Hakim Ghani, Joanna Pepke-Zaba","doi":"10.1016/j.healun.2026.04.026","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.026","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816303","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}