Journal of Heart and Lung Transplantation最新文献

{"title":"Summary of the International Society for Heart and Lung Transplantation consensus conference on emerging understanding of antibodies and antibody-mediated rejection in heart transplantation.","authors":"Jon Kobashigawa, Andreas Zuckermann, Adriana Zeevi, Markus J Barten, Patricia P Chang, Monica Colvin, Guillaume Coutance, Anne Dipchand, Stephan Ensminger, Marta Farrero, Marlena Habal, Anne Halpin, Annette M Jackson, Yosef Manla, Kavitha Muthiah, Luciano Potena, Elaine F Reed, Kelly Schlendorf, Palak Shah, Anat Tambur, Simon Urschel, Steven Webber, Lori West, Jong-Chan Youn, Jignesh Patel","doi":"10.1016/j.healun.2025.02.1690","DOIUrl":"10.1016/j.healun.2025.02.1690","url":null,"abstract":"<p><p>The understanding of circulating antibodies and their relationship to antibody-mediated rejection (AMR) has yet to be fully elucidated in heart transplantation. Circulating antibodies are important in both pretransplant and post-transplant. In the pretransplant period, the more antibodies detected in a patient awaiting heart transplantation often significantly reduces the chance of obtaining a compatible donor heart. In the post-transplant period, de novo antibody development against the donor heart remains a challenge to manage. In both pre- and post-transplant scenarios, it is not known what approach is optimal for treating these patients with circulating antibodies. To address these unmet needs, a consensus conference was organized on April 18, 2023, endorsed by the International Society for Heart and Lung Transplantation. The conference represented a collaborative multidisciplinary effort by experts in cardiothoracic transplantation from across the world to understand and discuss the optimum approach and treatment of circulating antibodies and AMR in heart transplant candidates and recipients. The conference served as a forum to better understand antibodies and AMR and their impact on transplant patients. The nature of this consensus is to prepare a platform and pave the way for further detailed studies. The findings and consensus statements are hereby presented.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266416","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":"Multi-Institutional Outcomes of Impella Use in Pediatric Patients: A Brief Communication from the ACTION Network.","authors":"Jonathan B Edelson, Shahnawaz Amdani, David N Rosenthal, Benjamin Kroslowitz, Brian Morray, Sabrina Law, Anna Joong, Sarah Wilkens, David M Peng, Michelle Ploutz, Jenna Murray, Jodie Lantz, Jesse J Esch, Mehreen Iqbal, Timothy Lancaster, Christina VanderPluym, Aamir Jeewa, Svetlana Shugh, Mohammad Absi, Muhammad Shezad, Matthew J O'Connor, Angela Lorts, Sebastian Tume","doi":"10.1016/j.healun.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.healun.2025.06.007","url":null,"abstract":"<p><p>This retrospective cohort study includes 150 pediatric patients supported with the Impella between 4/2018-11/2024. Median weight was 62.9kg (IQR 51.0-79.7kg) and the smallest weighed 19.0kg. Axillary artery implants occurred in 40.1% of patients while the femoral artery was used in 29%. Most patients had dilated cardiomyopathy (57.3%), however, a significant portion had transplant graft dysfunction (14.7%) or congenital heart disease (13.3%). One quarter of the cohort (N=38) were supported with ECMO prior to Impella; 76% (N=29) used ECMO and Impella in tandem, while 24% (N=9) transitioned from ECMO to Impella. Major bleeding, major infection, device malfunction, or stroke were reported in 28% of patients (N=42). Positive clinical outcomes were achieved in 89.3% of patients; 32.7% explanted for recovery, 32% transplanted, and 23.3% changed to another device. These data demonstrate a potential role for this device in children with refractory advanced heart failure, and a need for increased work to limit adverse events.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284962","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":"Plasma-Supplemented Red Cell Concentrates as Alternatives to Whole Blood in Porcine Ex Vivo Heart Perfusion.","authors":"Kiarra Durand, Celina Phan, Sanaz Hatami, Mitchell Wagner, Larissa Lautner, Mackenzie Brandon-Coatham, Carly Olafson, Darren H Freed, Jason P Acker","doi":"10.1016/j.healun.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.healun.2025.06.002","url":null,"abstract":"<p><strong>Background: </strong>Normothermic ex vivo organ perfusion holds promise for increasing the organ donor pool, however standard use of autologous whole blood (WB) presents logistical and functional challenges. This study compared red cell concentrate (RCC)-, rejuvenated RCC-, and WB-based perfusates over a 4-hour ex vivo heart perfusion (EVHP) to assess blood quality and its impact on myocardial function.</p><p><strong>Methods: </strong>Porcine WB was leukodepleted and hypothermically stored until perfusion. RCCs were divided into five perfusate groups (n=3, unless otherwise indicated): (A) WB with 14-day-stored RCCs (n=2), (B) 14-day-stored RCCs alone, (C) 14-day-stored RCCs with plasma, (D) day-14 rejuvenated RCCs, perfused on day 14 of storage with plasma, (E) day-14 rejuvenated RCCs, perfused on day 21 of storage with plasma. All groups were compared to WB (n=5). At the start, and after 4 hours of perfusion, measurements of coronary flow, cardiac index, oxygen extraction, oxygen consumption, metabolites, RBC indices, hemolysis, extracellular potassium, methemoglobin, p50, morphology, osmotic fragility, and deformability were collected.</p><p><strong>Results: </strong>Plasma-containing perfusates showed increased coronary flow, cardiac index, and initial oxygen consumption. After four hours, glucose concentrations in RCC-based solutions decreased, while hemolysis increased in most groups. Both rejuvenated RCC groups had lower extracellular potassium concentrations and improved oxygen affinity. WB-based perfusates demonstrated better RBC deformability and reduced fragility.</p><p><strong>Conclusions: </strong>Plasma is crucial for maintaining perfusate and myocardial quality in porcine EVHP models. RCC-based perfusates alongside plasma offer comparable quality to WB, potentially addressing some of the logistical challenges faced by EVHP, though this remains to be translated to humans.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258147","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":"Time to rethink the prioritization of IABP patients in heart allocation systems worldwide?","authors":"C Delmas, C Vandenbriele, G Baudry","doi":"10.1016/j.healun.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.healun.2025.06.001","url":null,"abstract":"<p><p>The intra-aortic balloon pump (IABP) remains widely used in clinical practice despite increasing evidence questioning its efficacy and safety. Designed as a simple temporary mechanical circulatory support device, IABP might offer benefits such as afterload reduction, cardiac output enhancement, and coronary perfusion improvement. However, large randomized controlled trials such as IABP-SHOCK II and CRISP MI have failed to demonstrate a survival benefit in acute myocardial infarction related cardiogenic shock. The ALTSHOCK2 study recently failed to show a clinical advantage of IABP-therapy in patients with heart failure-related cardiogenic shock. The use of IABP as a bridge to transplantation is particularly common in countries where national allocation systems prioritize patients on IABP support. The results of the recent ALTSHOCK2-trial question the justification for its continued inclusion in prioritization models. Hence, we examine the physiological effects of IABP, its application in shock states and low cardiac-output syndrome, and its role in transplantation allocation policies worldwide. In line with the present data, we call for a reevaluation of its role in clinical practice and transplant allocation to align with strong clinical evidence.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248178","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":"Pediatric Heart Transplantation within the Scandiatransplant Region - A Multinational Observational Study Spanning 38 years.","authors":"Oscar van der Have, Karin Tran-Lundmark, Håkan Wåhlander, Anu K Kaskinen, Thomas Möller, Klaus Juul, Timo Jahnukainen, Ilse Duus Weinreich, Taisto Sarkola, Johan Nilsson, Michal Odermarsky","doi":"10.1016/j.healun.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.healun.2025.05.020","url":null,"abstract":"<p><strong>Background: </strong>Thirty-eight years of pediatric heart transplantation (pHTx) within the Scandiatransplant organization were analyzed to describe volume trends, regional prevalence, underlying etiologies and outcomes following listing and pHTx.</p><p><strong>Methods: </strong>Children <18 years listed for pHTx from January 1^st 1986 to December 31^st 2023 were identified in the Scandiatransplant registry. The cohort was split into groups based on the era of listing (ERA I; 1986 - 1998, ERA II; 1999 - 2011, and ERA III; 2012 - 2023).</p><p><strong>Results: </strong>A total of 597 children were listed and 461 (77.2%) reached pHTx. The regional incidence of pHTx was 4.0 per 100,000 live births. All centers performed a median of <4 pHTx per year. 6.5% were transplanted at less than one year of age. Waiting list duration increased over time, withdrawal frequency remained stable, and listing mortality decreased from 22.8% in ERA I to 6.8% in ERA III. The distribution of listing and transplant diagnoses were not different between eras. ABO-incompatible transplants increased over time, from 1.0% in ERA I to 8.8% in ERA III, as did transplant from ventricular assist devices (6.6% in ERA I, 19.9% in ERA III). Post-transplant survival was 78.0% at 10 years and 51.4% at 30 years. Survival was worse in patients with etiology of congenital heart disease compared with cardiomyopathies. Era of listing was determinant of listing mortality, but not of post-transplant survival.</p><p><strong>Conclusions: </strong>Numbers of pHTx in the Scandiatransplant region are low but have increased with time. There has been a significant decrease in wait list mortality over time, whereas improvements in post-pHTx outcomes have been less evident, most likely due to excellent short-term outcomes for the first graft recipients in the region.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248177","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":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(25)02009-1","DOIUrl":"10.1016/S1053-2498(25)02009-1","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 7","pages":"Page A2"},"PeriodicalIF":6.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205521","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":"Reasons for donor heart offer refusal in the United States: Results from 14,132 transplant clinician surveys in the Donor Heart Study","authors":"Brian Wayda MD, MPH ,&nbsp;Helen Luikart RN ,&nbsp;Yingjie Weng MHS ,&nbsp;Shiqi Zhang MS ,&nbsp;Nikole Neidlinger MD ,&nbsp;R. Patrick Wood MD ,&nbsp;Javier Nieto MD ,&nbsp;Bruce Nicely RN, MSN ,&nbsp;John Belcher BS ,&nbsp;Tahnee Groat MPH ,&nbsp;Darren Malinoski MD ,&nbsp;Jonathan Zaroff MD ,&nbsp;Kiran K. Khush MD, MAS","doi":"10.1016/j.healun.2025.02.1698","DOIUrl":"10.1016/j.healun.2025.02.1698","url":null,"abstract":"<div><h3>Background</h3><div>Despite a shortage of donors for heart transplant (HT) in the United States, most potential donor hearts are discarded. We evaluated the reasons why and their temporal and geographic variation using a US-wide survey of HT clinicians.</div></div><div><h3>Methods</h3><div>The Donor Heart Study enrolled 4,333 adult potential heart donors in United States from 2015-2020. Separately by donor, each HT center that refused an offer for that donor was surveyed on their reason(s) for refusal. We measured the prevalence of 28 distinct donor-unrelated reasons for refusal and characterized their temporal and geographic variation.</div></div><div><h3>Results</h3><div>Of 14,132 surveys collected—each representing a single declined donor offer—donor-specific, recipient, and mismatch issues were cited in 49.3%, 24.3%, and 38.0%, respectively. Among surveys citing only donor-specific issues, the most common were age, coronary artery disease, left ventricular (LV) systolic dysfunction, and LV hypertrophy; other noncardiac issue(s) (e.g., drug use) were the sole reason in 20.6% of surveys citing only donor-specific issues. Donor age as a reason for offer refusal became increasingly prevalent over time, despite no accompanying change in the prevalence of older (50+ year-old) donors. Reasons for offer refusal varied widely by region, in a manner unexplained by regional differences in objective donor characteristics.</div></div><div><h3>Conclusions</h3><div>Our findings highlight the subjective nature of donor heart assessment. Further scrutiny of non–evidence based reasons for refusal could reduce discard of viable donor hearts.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 7","pages":"Pages 1075-1082"},"PeriodicalIF":6.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205525","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 transplant candidates' quadriceps strength is a modifiable predictor of recovery in exercise capacity after transplantation.","authors":"James R Walsh, Norman R Morris, Stephanie T Yerkovich, Matthew P Linnane, Daniel C Chambers, Peter Ma Hopkins","doi":"10.1016/j.healun.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.healun.2025.05.018","url":null,"abstract":"<p><strong>Background: </strong>Defining a transplant candidate's suitable functional status and potential for rehabilitation is complex. Six-minute walk distance (6MWD) criteria are used in candidacy assessment and pre-transplant quadriceps strength may be a predictor of rehabilitation potential. The study aims were to determine if candidates pre-transplant 6MWD and quadriceps strength are independent factors associated with post-transplant 6MWD and, compare the trajectory in 6MWD and quadriceps strength in candidates from initial assessment to waitlisting and from waitlisting to transplanted (or delisted/died).</p><p><strong>Methods: </strong>An observational repeated measures design was used. 6MWD and QS% were recorded at initial assessment, waitlisting, bi-monthly reassessments until transplanted/delisted/died and 2-, 6- 13- 26- and 52-weeks following transplantation.</p><p><strong>Results: </strong>342 (192 males; mean (±SD) age 51±14 years; 119 COPD, 93 IIP, 72 cystic fibrosis and 58 other) were studied. Recipients had a mean increase in 6MWD of 170±127 m (p<0.001) at 52-weeks post. Weekly 6MWD recovery was greater during the 2- and 6-week period (β 21.73, p<0.001) compared to the 6- to 52-week period (β 1.28, p<0.001). In the 2- to 6-weeks after transplantation, greater pre-transplant 6MWD (p<0.001), stronger pre-transplant QS% (p=0.001), shorter post-operative hospital admission (p<0.001) and cystic fibrosis (vs other) were factors associated with a greater 6MWD. In the 6- to 52-weeks after transplantation, stronger QS% value at corresponding time (p<0.001), younger recipients (p<0.001) and greater 2-week post-transplant 6MWD (p<0.001) were factors associated with a greater 6MWD. Pre-transplant 6MWD decreased by -0.059m (p<0.001) and QS% increased by 0.014% (p<0.001) per day between initial assessment to waitlisting (n=287).</p><p><strong>Conclusions: </strong>Pre-transplant 6MWD and quadriceps strength are independent factors associated with recovery in exercise capacity after lung transplantation. However, candidates had a marked deterioration in 6MWD, but quadriceps strength had improved while being worked up for waitlisting. Quadriceps strength along with 6MWD should be considered when determining a candidate's lung transplant suitability.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248254","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":"Barriers and Opportunities in Donation after Circulatory Death Heart Transplantation.","authors":"Katherine G Phillips, Darren Stewart, Brian Wayda, Kelly Drozdowicz, Lena Trager, Alex Reyentovich, Marzia Leacche, Amit Alam, Nader Moazami","doi":"10.1016/j.healun.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.healun.2025.05.019","url":null,"abstract":"<p><strong>Background: </strong>Heart utilization from donation after circulatory death (DCD) donors remains highly variable across the United States, potentially resulting in missed transplantation opportunities. This study aimed to quantify the frequency of clinically viable, non-utilized DCD hearts and identify usage barriers.</p><p><strong>Methods: </strong>We conducted a retrospective, national registry analysis of donors ≤55 years old who donated ≥1 organ, focusing primarily on DCDs. Donor characteristics, particularly age, warm ischemic time (WIT), and EF, as well as reasons for non-recovery and offer refusal, were analyzed. SRTR's heart yield model was employed to identify non-utilized DCD hearts clinically comparable to transplanted DCD hearts.</p><p><strong>Results: </strong>In 2023, 613 DCD hearts were transplanted, accounting for 13.5% of all heart transplants. Only 15.5% of DCD hearts from donors ≤55 years old were utilized. Marked variation in risk-adjusted DCD heart yield was observed between states, OPOs, and Regions. Donors of transplanted DCD hearts had a median age of 32, WIT 24 minutes, and EF 63%. The yield model identified between 701-1,243 non-utilized DCD hearts with characteristics comparable to transplanted cases. Concerns about delayed progression to circulatory arrest after life support withdrawal was a key reason for non-utilization.</p><p><strong>Conclusions: </strong>Despite wider acceptance of DCD heart transplantation, an increasing proportion of DCD hearts remain unused despite favorable characteristics. Concerns related to delayed progression to circulatory arrest are a significant barrier to heart utilization. Addressing geographic variability and improving predictive models for donor viability could double DCD heart utilization and expand heart transplantation volume by approximately 700-1,200 (15-27%) annually.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248253","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":"Additional bidirectional Glenn anastomosis for managing right ventricular failure under left ventricular assist device circulation","authors":"Tomoki Ushijima MD, PhD ,&nbsp;Takeo Fujino MD, PhD ,&nbsp;Hiromichi Sonoda MD, PhD ,&nbsp;Yusuke Ando MD, PhD ,&nbsp;Akira Shiose MD, PhD","doi":"10.1016/j.healun.2025.02.1682","DOIUrl":"10.1016/j.healun.2025.02.1682","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 7","pages":"Pages 1186-1188"},"PeriodicalIF":6.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205626","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}