Journal of Heart and Lung Transplantation最新文献

{"title":"The ACTION VAD registry: A collective five-year experience","authors":"Jonathan B. Edelson MD ,&nbsp;Alexander Raskin ,&nbsp;Mohammed Absi ,&nbsp;Iki Adachi ,&nbsp;Othman Aljohani ,&nbsp;Anaam Alzubi ,&nbsp;Shahnawaz Amdani ,&nbsp;Alfred Asante-Korang ,&nbsp;Scott Auerbach ,&nbsp;Neha Bansal ,&nbsp;David Bearl ,&nbsp;Katerina Boucek ,&nbsp;Arene Butto ,&nbsp;Ryan Butts ,&nbsp;Jonathan Byrnes ,&nbsp;Chesney Castleberry ,&nbsp;Jennifer Conway ,&nbsp;Nhue Do ,&nbsp;John Dykes ,&nbsp;Joshua Friedland-Little ,&nbsp;Robert Niebler MD","doi":"10.1016/j.healun.2025.01.007","DOIUrl":"10.1016/j.healun.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) began in 2018 as a collaborative learning health system committed to improving outcomes in pediatric heart failure, including children and adults with congenital heart disease, supported with ventricular assist devices (VADs). This report describes patient and device characteristics, and outcomes through 1-year post-implant.</div></div><div><h3>Methods</h3><div>The ACTION VAD registry report was created from data submitted to the ACTION learning network from April 2018 to June 2023. It includes 1,430 devices implanted in 1,220 pediatric patients (≤18) from 57 sites across North America.</div></div><div><h3>Results</h3><div>Males comprised 55% of the registry patients. The median age was 3.7 years with a median implant weight of 13.6 kg; 36% of the cohort was &lt;10 kg. Nearly 40% of patients had a primary diagnosis of congenital heart disease (CHD). Patients with CHD represented 26% of VAD implants in 2018 which increased to 42% in 2023 (<em>p</em> <!-->=<!--> <!-->0.03). At implant, 25% of patients were supported with extracorporeal membrane oxygenation (ECMO), 4.9% with dialysis, and 54% were mechanically ventilated. Paracorporeal pulsatile pumps comprised 40.2% of implants, followed in incidence by paracorporeal continuous flow (28.5%), and implantable continuous flow (24.1%). The number of patients in the VAD Registry patients increased from 102 in 2018 to 256 in 2022, partly reflecting increased center participation in ACTION. Overall survival on support at 1 year was 79.2%, and the incidence of stroke was 13.7%. Infants demonstrated the poorest outcomes, with a 1-year survival of 72.9% and a higher incidence of stroke (20.8%).</div></div><div><h3>Conclusion</h3><div>The 5-year ACTION VAD experience highlights the growing collaboration in the pediatric VAD community and changes in clinical practice. More work is needed to improve survival and limit adverse outcomes, especially in younger patients.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 4","pages":"Pages 530-540"},"PeriodicalIF":6.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991700","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":"Short and long-term outcomes of lung transplantation from brain death vs. circulatory death donors: A meta-analysis of comparative studies.","authors":"Cristiano Spadaccio, Antonio Salsano, Salah Altarabsheh, Alejandra Castro-Varela, Carlos Gallego Navarro, Fernando Juarez Casso, Ahmed Abdelrehim, Kartik Andi, Rafaela V P Ribeiro, Kukbin Choi, Gustavo Knop, Cassie C Kennedy, Kelly M Pennington, Philip J Spencer, Richard Daly, Mauricio Villavicencio, Marcelo Cypel, Sahar A Saddoughi","doi":"10.1016/j.healun.2024.12.010","DOIUrl":"10.1016/j.healun.2024.12.010","url":null,"abstract":"<p><strong>Background: </strong>To investigate through a meta-analysis of comparative studies the impact of donor type (brain death DBD vs circulatory death DCD) on the short- and long-term outcomes of lung transplantation(LTx).</p><p><strong>Methods: </strong>Literature search (terms \"lung transplantation\" AND \"donation after circulatory death\") was performed up to July 2022 and studies comparing outcomes of LTx from DCD versus DBD were selected. Primary endpoints were early and long-term mortality. Secondary outcomes included primary graft dysfunction (PGD),acute rejection and postoperative complications. The long-term survival was analyzed by retrieving data from each available Kaplan-Meier and restricted mean survival time difference between DBD and DCD for long-term survival was estimated.</p><p><strong>Results: </strong>21 studies were included comprising 60105 patients (DBD=58548 DCD=1557). Recipient and donor baseline characteristics were similar between the two groups. No significant publication bias was observed. The estimated pooled odds ratio of early mortality favored DBD (OR=0.75,CI=0.56-1.00, I²=0%). No statistically significant difference was observed in the risk of acute rejection (OR=1.33, CI=0.82-2.17), and PGD grade 2-3 (OR=0.88, CI=0.69-1.13). One- and 5-year survival were 82.1% and 51.2%, and 86.2% and 62.7% for DBD and DCD groups, respectively (Log-rank,p<0.0001). Unadjusted hazard ratio was 0.693, with DCD as reference. DCD lungs demonstrated improved survival by 4.82% over 5-years when compared to DBD lungs.</p><p><strong>Conclusions: </strong>This meta-analysis of comparative studies between DCD and DBD demonstrates significant long-term survival advantage of DCD LTx despite an initial small but statistically significant increased mortality risk in the short-term. Data supports the continued implementation of DCD to increase the lung donor pool.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971125","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":"Early Results of an Infant Model of Orthotopic Cardiac Xenotransplantation","authors":"Chace B. Mitchell MD ,&nbsp;Joe Simmons DVM, PhD ,&nbsp;Carolyn L. Hodo DVM, PhD ,&nbsp;Sarah J. Neal PhD ,&nbsp;Sriram Chitta PhD ,&nbsp;Clementine Vo DO ,&nbsp;Kanwarpal Bakshi MD ,&nbsp;Julie Juliani CCP, FPP ,&nbsp;Julie Fenske CCP ,&nbsp;David C. Cleveland MD ,&nbsp;John D. Cleveland MD","doi":"10.1016/j.healun.2024.12.011","DOIUrl":"10.1016/j.healun.2024.12.011","url":null,"abstract":"<div><h3>Background</h3><div>Genetically engineered porcine hearts may have an application for infants in need of a bridge to cardiac allotransplantation. The current animal model that resulted in 2 human applications has been validated in adult non-human primates only. We sought to create an infant animal model of life sustaining cardiac xenotransplantation to understand limitations specific to this age group.</div></div><div><h3>Methods</h3><div>We performed 11 orthotopic cardiac xenotransplants from genetically modified infantile pigs into size-matched baboons (<em>Papio</em> spp). Porcine grafts were preserved using a modified Del Nido solution. Protocolized post-operative care and outcomes were tracked with invasive monitoring, echocardiogram, and serial chemistries (including a 7-cytokine panel).</div></div><div><h3>Results</h3><div>Mean ischemic time was 52.1 +/- 13.9 min. All porcine hearts separated from bypass in normal sinus rhythm with normal systolic function documented by echocardiogram at chest closure and again at 24 h. In the first 48 post-operative hours, mean vasoactive inotropic score for the recipients was 9.6 +/- 3.5. Survival &gt;3months was achieved in 6 animals. Five animals succumbed early (&lt;7days) either due to errors in care (n=2) or pulmonary complications (n=3) confirmed on chest radiograph and necropsy. Cytokine levels objectively increased following xenograft implant but were not significantly different between survivors and non-survivors.</div></div><div><h3>Conclusions</h3><div>In a non-human primate model of infant orthotopic cardiac xenotransplantation, cardiac function does not hinder early peri-operative survival. Instead, pulmonary edema and pleural effusions in the setting of systemic inflammation preclude clinical progression. Targeted therapies are necessary to encourage prolonged survival.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 4","pages":"Pages 503-510"},"PeriodicalIF":6.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950040","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":"Bridge to simultaneous heart-kidney transplantation via extracorporeal life support: National outcomes in the new heart allocation policy era","authors":"Iris Feng BS ,&nbsp;Paul A. Kurlansky MD ,&nbsp;Yanling Zhao MS, MPH ,&nbsp;Krushang Patel MD ,&nbsp;Morgan K. Moroi MD ,&nbsp;Alice V. Vinogradsky BA ,&nbsp;Farhana Latif MD ,&nbsp;Gabriel Sayer MD ,&nbsp;Nir Uriel MD ,&nbsp;Yoshifumi Naka MD, PhD ,&nbsp;Koji Takeda MD, PhD","doi":"10.1016/j.healun.2024.08.020","DOIUrl":"10.1016/j.healun.2024.08.020","url":null,"abstract":"<div><h3>Background</h3><div>Since United Network for Organ Sharing (UNOS) revised their heart allocation policy in 2018, usage of veno-arterial extracorporeal life support (VA-ECLS) has dramatically increased as a bridge to transplant. This study investigated outcomes of VA-ECLS patients bridged to simultaneous heart-kidney transplant (SHK) in the new policy era.</div></div><div><h3>Methods</h3><div>This study included 774 adult patients from the UNOS database who received SHK between 10/18/18 and 12/31/21 and compared patients bridged to transplant on VA-ECLS (<em>n</em> = 50) with those not bridged (<em>n</em> = 724).</div></div><div><h3>Results</h3><div>At baseline, SHK recipients bridged from VA-ECLS were younger (50.5 vs 58.0 years, <em>p</em> = 0.007), had higher estimated glomerular filtration rate (eGFR) at time of transplant (47.6 vs 30.1, <em>p</em> &lt; 0.001), and spent fewer days on the waitlist (7.0 vs 33.5 days, <em>p</em> &lt; 0.001). In the perioperative period, VA-ECLS was associated with higher rates of temporary dialysis (56.0% vs 28.0%, <em>p</em> &lt; 0.001) but similar 2-year cumulative incidence of chronic dialysis (7.5% vs 5.4%, <em>p</em> = 0.800) and renal allograft failure (12.0% vs 8.1%, <em>p</em> = 0.500) compared to non-ECLS cohort. However, VA-ECLS patients had decreased survival to discharge (76.0% vs 92.7%, <em>p</em> &lt; 0.001) and 2-year post-transplant survival (71.7% vs 83.0%, <em>p</em> = 0.004), as well as greater 2-year cumulative incidence of cardiac allograft failure (10.0% vs 2.7%, <em>p</em> = 0.002). Multivariable analyses found VA-ECLS at time of transplant to be independently associated with 2-year post-transplant mortality (HR [95% CI]: 3.40 [1.66–6.96], <em>p</em> = 0.001) and cardiac allograft failure (sub-distribution hazard ratio [SHR] [95% CI]: 8.51 [2.77–26.09], <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Under the new allocation policy, patients bridged to SHK from VA-ECLS displayed greater early mortality and cardiac allograft failure but similar renal outcomes compared to non-ECLS counterparts.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 1","pages":"Pages 11-21"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154308","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":"Detailed cellular and spatial characterization of chronic lung allograft dysfunction using imaging mass cytometry","authors":"Benjamin Renaud-Picard ,&nbsp;Sajad Moshkelgosha ,&nbsp;Gregory Berra ,&nbsp;May Cheung ,&nbsp;David Hwang ,&nbsp;David Hedley ,&nbsp;Stephen Juvet ,&nbsp;Tereza Martinu","doi":"10.1016/j.healun.2024.09.023","DOIUrl":"10.1016/j.healun.2024.09.023","url":null,"abstract":"<div><div>Long-term survival after lung transplantation remains limited by chronic lung allograft dysfunction (CLAD), with 2 main phenotypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). We aimed to assess CLAD lung allografts using imaging mass cytometry (IMC), a high dimensional tissue imaging system allowing a multiparametric in situ exploration at a single cell level. Four BOS, 4 RAS, and 4 control lung samples were stained with 35 heavy metal-tagged antibodies selected to assess structural and immune proteins of interest. We identified 50 immune and non-immune cell clusters. CLAD lungs had significantly reduced club cells. A Ki67-high basal cell population was mostly present in RAS and in proximity to memory T cells. Memory CD8⁺ T cells were more frequent in CLAD lungs, regulatory T cells more prominent in RAS. IMC is a powerful technology for detailed cellular analysis within intact organ structures that may shed further light on CLAD mechanisms.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 1","pages":"Pages 118-124"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(24)01992-2","DOIUrl":"10.1016/S1053-2498(24)01992-2","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 1","pages":"Page A2"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158863","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":"Authors’ response to comment and opinion","authors":"Anthony P. Carnicelli MD ,&nbsp;Jennifer Cowger MD ,&nbsp;Ryan J. Tedford MD ,&nbsp;Manreet Kanwar MD","doi":"10.1016/j.healun.2024.09.014","DOIUrl":"10.1016/j.healun.2024.09.014","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 1","pages":"Pages 131-132"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348134","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":"Impact of preoperative body mass index on long-term survival, quality of life, and functional outcomes after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: Results from the UK National Cohort","authors":"Stephen Chiu MD ,&nbsp;Katherine Bunclark MB, ChB ,&nbsp;Paula Appenzeller MD ,&nbsp;Hakim Ghani MD, MSc ,&nbsp;Dolores Taboada MD, MPhil ,&nbsp;Karen Sheares MD, PhD ,&nbsp;Mark Toshner MB, ChB, PhD ,&nbsp;Joanna Pepke-Zaba PhD, FRCP ,&nbsp;John Cannon MRCP, PhD ,&nbsp;Fouad Taghavi MB, ChB, MD ,&nbsp;Steven Tsui MBBS, MD ,&nbsp;Choo Ng MB, BCh ,&nbsp;David P. Jenkins MBBS, FRCS(CTh)","doi":"10.1016/j.healun.2024.09.005","DOIUrl":"10.1016/j.healun.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have demonstrated the safety of pulmonary endarterectomy (PEA) across body mass index (BMI) strata. However, long-term survival and patient-reported outcome measures by BMI strata remain unknown. We examined the impact of preoperative BMI on long-term survival, QOL, and functional outcomes for patients undergoing PEA for chronic thromboembolic pulmonary hypertension (CTEPH).</div></div><div><h3>Methods</h3><div>Retrospective review of 2,004 patients from the UK National Cohort between 2007 and 2021 undergoing PEA for CTEPH (mean pulmonary artery pressure &gt;20 mm Hg and pulmonary vascular resistance &gt;160 dynes). Patients were stratified into BMI&lt;20, 20 to 29, 30 to 39, 40 to 49, and 50+. All-cause mortality was the primary outcome measure. Secondary outcome measures were 3- to 6-month postoperative hemodynamics, 6-minute walk distance (6MWD), New York Heart Association (NYHA) class, and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) scores.</div></div><div><h3>Results</h3><div>Hemodynamics and 6MWD at 3 to 6 months were similar across BMI strata. Patients with BMI 50+ reported the highest incidence of postoperative NYHA III/IV limitation (53.3%, <em>p &lt;</em> 0.001) and the highest residual symptom burden by CAMPHOR <em>(p</em> &lt; 0.001)<em>.</em> Five-year survival was lowest in patients with BMI 50+ (70.2%) and BMI&lt;20 (73.4%), while highest in BMI 30 to 39 (88.2%, <em>p</em> = 0.008). Ten-year Kaplan-Meier estimates predicted the lowest survival in BMI 50+ and BMI&lt;20.</div></div><div><h3>Conclusions</h3><div>PEA remains safe and effective for all patients regardless of BMI. Despite similar hemodynamic outcomes, patients with BMI 50+ are at the greatest risk of long-term all-cause mortality, and patients with BMI 50+ experience residual symptomatic limitation.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 1","pages":"Pages 25-32"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231282","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":"Defining direct and indirect right ventricular unloading","authors":"Jamel Ortoleva MD, FASE,&nbsp;Dominic V. Pisano MD","doi":"10.1016/j.healun.2024.08.025","DOIUrl":"10.1016/j.healun.2024.08.025","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 1","pages":"Pages 129-130"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372047","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":"Clinical outcomes after a biopsy diagnosis of antibody-mediated rejection in pediatric heart transplant recipients","authors":"Melanie D. Everitt MD ,&nbsp;Elfriede Pahl MD ,&nbsp;Devin A. Koehl MSDS ,&nbsp;Ryan S. Cantor PhD ,&nbsp;James K. Kirklin MD ,&nbsp;Amy Christine Reed FNP ,&nbsp;Philip Thrush MD ,&nbsp;Matthew Zinn DO ,&nbsp;Amanda D. McCormick MD ,&nbsp;Jessie Yester MD, PhD ,&nbsp;Jenna S. Schauer MD ,&nbsp;Donna W. Lee CPNP","doi":"10.1016/j.healun.2024.08.017","DOIUrl":"10.1016/j.healun.2024.08.017","url":null,"abstract":"<div><h3>Background</h3><div>Extending survival after heart transplant (HT) is of paramount importance for childhood recipients of HT. Acute rejection is a significant event, and biopsy remains the most specific means for distinguishing between cellular (ACR) and antibody-mediated rejection (AMR).</div></div><div><h3>Methods</h3><div>All children in the Pediatric Heart Transplant Society Registry who underwent HT between January 2015 and June 2022 and had ≥1 rejection episode were included. Survival was compared between AMR and ACR-only. Secondary outcomes of infection, malignancy, and cardiac allograft vasculopathy (CAV) were assessed. Risk factors for graft loss after AMR were identified using Cox proportional hazard modeling.</div></div><div><h3>Results</h3><div>Among 906 children with rejection, 697 (77%) with complete biopsy information were included. AMR was present on biopsy in 261 (37%) patients; ACR-only was present in 436 (63%). Time to rejection was earlier for AMR, median time from HT to rejection 0.11 versus 0.29 years, <em>p</em> = 0.0006. Survival after AMR in the 1st year was lower than survival after ACR-only. Predictors of graft loss after AMR were younger age at HT, congenital heart disease, and rejection with hemodynamic compromise. There was no difference in time to CAV, infection, or malignancy after rejection between groups.</div></div><div><h3>Conclusions</h3><div>The largest analysis of pediatric HT rejection with biopsy data to identify AMR underscores the continued importance of AMR on survival. AMR is associated with higher graft loss versus ACR when occurring in the first-year post-HT. Predictors of graft loss after AMR identify patients who may benefit from increased surveillance or augmented maintenance immunosuppression.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 1","pages":"Pages 82-91"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140237","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}