Journal of Heart and Lung Transplantation最新文献

{"title":"Thin blood and thinner margins in anticoagulation with left ventricular assist devices: Living on the Razor's Edge.","authors":"Ameesh Isath, Mandeep R Mehra","doi":"10.1016/j.healun.2025.05.016","DOIUrl":"10.1016/j.healun.2025.05.016","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225685","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":"200 Cases of Cardiac Donation after Circulatory Death Utilizing Normothermic Regional Perfusion: The Four-Year Vanderbilt Experience.","authors":"Aaron M Williams, Awab Ahmad, Swaroop Bommareddi, Brian Lima, Chetan Pasrija, Duc Nguyen, Mark Petrovic, Chen Chia Wang, Eric Quintana, Hasan K Siddiqi, Kaushik Amancherla, D Marshall Brinkley, JoAnn Lindenfeld, Jonathan Menachem, Henry Ooi, Dawn Pedrotty, Stacy Tsai, Lynn Punnoose, Aniket S Rali, Suzanne Sacks, Mark Wigger, Sandip Zalawadiya, Stephen A DeVries, Clifton D Keck, Shelley R Scholl, Anthony J Lepore, Matthew Warhoover, Kelly Schlendorf, Ashish S Shah, John M Trahanas","doi":"10.1016/j.healun.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.healun.2025.05.007","url":null,"abstract":"<p><strong>Objectives: </strong>Studies evaluating normothermic regional perfusion (NRP) for donation after circulatory death (DCD) heart recovery involve low volume centers or multi-center studies with wide variation in practice/technique. We sought to provide a single high-volume center's experience encompassing our program's evolution of NRP over time.</p><p><strong>Methods: </strong>Adult DCD heart transplant patients who received cardiac allografts recovered using only thoracoabdominal NRP were retrospective reviewed from October 2020 to November 2024. Donor and recipient pairs were divided into 4 groups (or Eras) based on year of transplant and compared. Hazard and confidence scores were compared highlighting changes in postoperative outcomes, and donor aggressiveness and high-risk recipients, respectively. NRP recovery details were compared.</p><p><strong>Results: </strong>Heart recovery attempts were made on 200 donors with 176 accepted for transplant (88%). Recipient postoperative outcomes demonstrated no significant difference across Eras. Functional warm ischemic time (FWIT) increased (p< 0.05) over the Eras. Cold ischemic time (CIT) also increased from Era 1 to Era 4 (p < 0.05). Allograft turn-downs due to technical reasons trended downwards from Era 1 (4/35, 11.5%) to Era 4 (1/62, 1.6%) (p = 0.16). The hazard score reflecting recipient outcomes was comparable across all four eras (p = 0.84), while the confidence score reflecting donor aggressiveness and high-risk recipients significantly increased (p < 0.05).</p><p><strong>Conclusions: </strong>Despite adopting a more aggressive approach with donor selection and high-risk recipients over time, technical improvements and evolution of the NRP recovery process has afforded continued excellent recipient outcomes that can be translatable to other centers.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208623","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 right ventricular reserve function during exercise on aortic valve opening in patients with left ventricular assist device.","authors":"Sakae Takenaka, Takuma Sato, Toshiyuki Nagai, Atsushi Tada, Yuta Kobayashi, Sho Kazui, Yutaro Yasui, Takeshi Hamaya, Yuki Mori, Akinori Takahashi, Suguru Ishizaka, Takao Konishi, Taro Temma, Kiwamu Kamiya, Tomonori Ooka, Satoru Wakasa, Toshihisa Anzai","doi":"10.1016/j.healun.2025.05.009","DOIUrl":"10.1016/j.healun.2025.05.009","url":null,"abstract":"<p><strong>Background: </strong>Although aortic valve (AV) opening during exercise has fewer adverse events in patients with a left ventricular (LV) assist device (LVAD), factors associated with it remain unclear. We hypothesized that right ventricular (RV) reserve function is associated with the AV opening status. This study aimed to explore the hemodynamic parameters observed at rest and during maximal exercise and investigate the association between the RV reserve function and AV opening status in patients with an LVAD.</p><p><strong>Methods: </strong>We prospectively examined 25 consecutive patients with an LVAD who underwent invasive exercise right heart catheterization with simultaneous echocardiography in the supine position. The AV opening status was assessed at rest and during exercise. The change in RV stroke work index (RVSWI) from rest to peak exercise (ΔRVSWI) was calculated to assess the RV reserve function. Patients were divided into three groups according to AV opening: AV opening both at rest and during exercise (n = 7), AV opening during exercise only (n = 8), and closed AV (n = 10).</p><p><strong>Results: </strong>Patients with a closed AV had significantly lower ΔRVSWI and ΔRV dP/dt max than those with AV opening both at rest and during exercise and AV opening during exercise only, whereas changes in pulmonary artery wedge pressure and pulmonary vascular resistance were comparable across the groups. In a multivariable logistic regression analysis, ΔRVSWI was independently associated with AV opening even after adjustment for the change in LV ejection fraction from rest to peak exercise. During a median follow-up period of 743 (interquartile range, 483-1037) days, the incidence of adverse events was higher in patients in the closed AV group than in those in the AV opening groups (p = 0.002).</p><p><strong>Conclusions: </strong>RV reserve function is associated with AV opening status in patients with an LVAD.</p><p><strong>Clinical trial registration: </strong>URL: https://www.umin.ac.jp/ctr/index.htm. Unique Identifier: UMIN000039001.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208624","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":"Salidroside-Loaded Metal-organic Frameworks Hydrogel to Improve Cardiac Allograft Function.","authors":"Pengyu Zhou, Jianqiang Ji, Zhong Zhang, Xiu Liu, Xuan Pan, Chuanjie Niu, Jun Wan, Chaofan Wen, Ruiling Wang, Shaoyi Zheng, Shuai Liu, Honghao Hou, Jun Lu","doi":"10.1016/j.healun.2025.05.015","DOIUrl":"https://doi.org/10.1016/j.healun.2025.05.015","url":null,"abstract":"<p><strong>Background: </strong>Ischemia-reperfusion injury (IRI) is a leading cause of primary graft dysfunction in heart transplantation. Metal-organic frameworks (MOFs) are widely applied as drug delivery carriers. Salidroside has been recognized for its potent anti-oxidative and anti-inflammatory effects. In this study, we developed the hydrogel incorporating salidroside-loaded MOF nanoparticles (Hydrogel/MOFSP) and applied it to the surface of post-transplant donor hearts to alleviate myocardial IRI.</p><p><strong>Methods: </strong>Hydrogel/MOFSP was synthesized to facilitate sustained and cardiac-targeted drug release for salidroside. We evaluated MOFSP nanoparticles or salidroside's anti-oxidative and anti-inflammatory properties in vitro. Furthermore, donor hearts were heterotopically transplanted after 3-hour cold storage with PBS (vehicle group), or salidroside or Hydrogel/MOFSP applied to the surface of donor hearts immediately after in vivo reperfusion. We investigated the cardiac function and the levels of oxidative stress, inflammation, and apoptosis of donor hearts after 6-hour heart transplantation and the mechanism of the cardioprotective effect of Hydrogel/MOFSP.</p><p><strong>Results: </strong>MOFSP nanoparticles or salidroside displayed anti-oxidative and anti-inflammatory properties in vitro, whereas applying Hydrogel/MOFSP rather than only salidroside to the surface of post-transplant grafts could improve cardiac function. Significantly reduced levels of myocardial oxidative stress, inflammation, and apoptosis were observed in the Hydrogel/MOFSP group. Hydrogel/MOFSP mitigated myocardial IRI for post-transplant grafts through the downregulation of P38/mitogen-activated protein kinase (MAPK) signaling pathway.</p><p><strong>Conclusions: </strong>Applying novel Hydrogel/MOFSP to the surface of post-transplant donor hearts improved graft function and alleviated myocardial IRI in heart transplantation. The cardioprotective effects of Hydrogel/MOFSP were achieved through the downregulation of the P38/MAPK signaling pathway.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208625","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":"Safety and efficacy intravenous istaroxime up to 60 hours for patients with pre-cardiogenic shock.","authors":"Jan Biegus, Alexandre Mebazaa, Marco Metra, Matteo Pagnesi, Ovidiu Chioncel, Beth Davison, Christopher Edwards, Koji Takagi, Gerasimos Filippatos, Agnieszka Tycińska, Maria Novosadova, Gaurav Gulati, Marianela Barros, Maria Luz Diaz, Carlos Guardia, Robert Zymliński, Piotr Gajewski, Piotr Ponikowski, Phillip Simmons, Steven Simonson, Gad Cotter","doi":"10.1016/j.healun.2025.05.013","DOIUrl":"10.1016/j.healun.2025.05.013","url":null,"abstract":"<p><strong>Background and aims: </strong>A drug that improves blood pressure and cardiac output (CO) while reducing pulmonary wedge pressure safely is needed for patients with cardiogenic shock (CS) due to acute heart failure (AHF).</p><p><strong>Methods: </strong>In a randomized, double-blind, placebo-controlled trial, istaroxime 0.5 to 1.5 µg/kg/min for 24-60 hours was administered to 48 patients, and placebo to 42 patients, with pre-CS due to AHF under hemodynamic monitoring. Echocardiographic and Holter monitoring were done in both parts.</p><p><strong>Results: </strong>Patients randomized to istaroxime had a greater increase in systolic blood pressure (SBP) during the first 6 hours (primary endpoint), ls-mean (SE) 62.0 (6.59) mmHg*hour vs 36.4 (7.11) in the placebo arm (LS mean difference of 25.6 mmHg*hour, 95% CI 7.2-44.0 mmHg*h, P = 0.007). In patients administered istaroxime for at least 48 hours, SBP increase persisted for 60 hours. Istaroxime led to a greater increase in CO (0.66 L/min, P = 0.017) and decrease in wedge pressure (3.8 mmHg, P = 0.0017). Relative to average baselines of 3.6 L/min for CO and 22.5 mmHg for wedge pressure, this translates into improvements of 18.3% and 16.9%, respectively. Echocardiographic assessments showed improvements in E/A, TAPSE, and LA volume at 24 hours. There were improvements in eGFR at 24-72 hours and NYHA class to 72 hours. NT-proBNP increased more in istaroxime-treated patients. Heart rate decreased more in the first 24 hours in istaroxime-treated patients. No significant malignant arrhythmias were detected in patients treated with istaroxime on Holter monitoring.</p><p><strong>Conclusions: </strong>In this small study, istaroxime doses of up to 1.0 µg/kg/min for up to 60 hours were associated with improvements in SBP, CO and reductions in wedge pressure and heart rate without increases in arrhythmias.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199355","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":"Biomarkers for human donor lung assessment during ex vivo lung perfusion.","authors":"Abby McCaig, Andrew Sage, Shaf Keshavjee, Mingyao Liu","doi":"10.1016/j.healun.2025.05.014","DOIUrl":"10.1016/j.healun.2025.05.014","url":null,"abstract":"<p><p>Lung transplantation remains the only curative treatment option for patients with end-stage lung disease, yet limited donor lung availability and utilization remains a significant obstacle. The ex vivo lung perfusion (EVLP) system allows for the extension of the donor assessment, providing the opportunity to perform advanced assessment on the isolated donor lung under near-physiological conditions. Measuring biomarkers in EVLP perfusate can provide valuable information on the condition of the donor lungs. This review examines biomarkers measured in EVLP perfusate and their ability to predict donor lung utilization and outcomes. Biomarkers in this review can be classified as cytokines, cell death, and endothelial-related molecules, showing potential for clinical application. Some of these biomarkers have also been used to monitor the effects of various therapeutics for donor lung repair or for modification of the EVLP technique. Yet, many limitations persist throughout these studies, which provides the opportunity for extensive future research. The integration of biomarkers with other data collected during EVLP through machine learning and artificial intelligence will lead to automated organ assessment to improve lung transplantation.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199353","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":"Study of angiogenic cell therapy for progressive pulmonary arterial hypertension: intervention with repeat dosing of eNOS-enhanced EPCs: the SAPPHIRE trial.","authors":"Duncan J Stewart, Sanjay Mehta, George Chandy, Naushad Hirani, John Granton, Nathan Hambly, John Swiston, Kim Danovitch, Elham Sabri, Antonio Giulivi, David W Courtman, Dean A Fergusson","doi":"10.1016/j.healun.2025.05.012","DOIUrl":"10.1016/j.healun.2025.05.012","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is characterized by widespread pruning of the distal pulmonary arterial bed, leading to increased pulmonary vascular resistance, right heart failure, and death. PAH patients receiving background therapy were randomized to receive a course of 4 monthly infusions of placebo or angiogenic endothelial progenitor cells (EPCs) transfected with endothelial NO synthase (eNOS) over the first 6-month period for a cumulative dose of 80 M cells. Due to the COVID-19 pandemic, the trial was stopped after 12 of the planned 45 patients were enrolled (five placebo, seven eNOS-EPCs). While the small sample size precluded appropriately powered analyses, a possible difference was seen in 6MWD between the eNOS-EPC and placebo groups over 6 months, with a greater proportion of patients in the cell therapy group achieving a minimal clinically important increase in 6MWD of 33-m (71.4% vs 40%, respectively). Treatment of PAH patients with a course of 4 monthly infusions of eNOS-EPCs was well tolerated and may have resulted in clinical benefit.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187126","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":"Hurry up and weight.","authors":"Arushi Singh, Bernard S Kadosh","doi":"10.1016/j.healun.2025.05.008","DOIUrl":"10.1016/j.healun.2025.05.008","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187115","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":"Revisiting co-stimulation blockade in lung transplantation: Insights from a RAS-type CLAD mouse model.","authors":"Emmanuel Zorn","doi":"10.1016/j.healun.2025.05.011","DOIUrl":"10.1016/j.healun.2025.05.011","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187117","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":"Efficacy and Safety of Belatacept in Heart Transplant Recipients.","authors":"Julia Baranowska, Daniel Oren, Andrea Fernandez Valledor, Matan Uriel, Changhee Lee, Cathrine Maria Moeller, Boaz Elad, Salwa Rahman, Adi Hertz, Devin Skoll, Matthew Regan, Ersilia M DeFilippis, Jayant Raikhelkar, Justin Fried, Dor Lotan, Kyung Taek Oh, David Bae, Afsana Rahman, Jason Choe, Kevin Clerkin, Adil A Yunis, Melana Yuzefpolskaya, Paolo C Colombo, David Majure, Farhana Latif, Gabriel Sayer, Nir Uriel","doi":"10.1016/j.healun.2025.04.023","DOIUrl":"https://doi.org/10.1016/j.healun.2025.04.023","url":null,"abstract":"<p><strong>Background: </strong>Contemporary immunosuppressive regimens following heart transplantation (HT) are associated with nephrotoxicity. Additionally, some patients develop rejection despite standard immunosuppression, requiring augmentation. Belatacept (BTC) has demonstrated mortality and graft survival benefits while preserving renal function in kidney transplant recipients, but data regarding HT remain limited. This study aimed to evaluate the utilization, safety, and efficacy of BTC-based therapy in HT recipients, comparing outcomes with patients managed under a standard immunosuppression protocol.</p><p><strong>Methods: </strong>This retrospective, single-center study evaluated all adult HT recipients treated with BTC between October 2019 and August 2023. Patients were stratified by indication (renal-sparing or enhanced immunosuppression) and propensity-matched to controls receiving standard immunosuppressive therapy. Primary outcomes were survival free from clinically significant rejection and changes in renal function post-BTC initiation.</p><p><strong>Results: </strong>BTC was started in 64 patients at a median of 20 [IQR 7-66] months following transplant (37 renal-sparing, 27 immunological). Median age was 51 years and 59% were male. Over a median follow-up of 26 months, rejection free survival was similar between BTC patients and controls (p=0.44). BTC initiation led to improved renal function, with increase in GFR from 38 to 43 ml/min/1.73m² (p=0.04). Infections occurred in 20% of BTC patients. EBV viremia occurred more frequently post-BTC initiation than before (40.6% vs. 7.8%, p<0.001). BTC treatment was associated with 98.5% 2-year survival.</p><p><strong>Conclusions: </strong>BTC may safely be used as an adjunct immunosuppressive agent in HT recipients with renal dysfunction or elevated immunological risk. A BTC-based regimen is associated with improved renal function compared to a standard regimen based on calcineurin inhibitors.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187114","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}