Journal of Heart and Lung Transplantation最新文献

{"title":"Aggressive donor heart acceptance and early outcomes after heart transplantation.","authors":"Shreya Ramineni, Lorenzo D'Angelo, Brandon Ferrell, Vagish Hemmige, Stephen Forest, Daniel B Sims, Omar Saeed, Daniel J Goldstein, Ulrich P Jorde, Shivank Madan","doi":"10.1016/j.healun.2026.09.010","DOIUrl":"10.1016/j.healun.2026.09.010","url":null,"abstract":"<p><p>Limited donor organ availability and variable acceptance practices continue to constrain heart transplantation (HT) access in the United States. We examined whether center-level donor offer acceptance (DOA) aggressiveness, measured by the OPTN-introduced DOA ratio was associated with early post-transplant outcomes for 5393 adult HTs across 106 U.S. transplant centers (January 2024 to June 2025). Centers were stratified into restrictive (Q1), intermediate (Q2-Q3), and aggressive (Q4) DOA quartiles. Aggressive-DOA centers utilized older donors, more DCD hearts, and accepted organs with greater travel distances. Despite this, 1-year recipient survival did not differ significantly across DOA groups in either Kaplan-Meier (p=0.253) or adjusted Cox proportional hazards analyses (p=0.277). Rates of severe primary graft dysfunction requiring ECMO, post-transplant stroke, and hemodialysis were also comparable. Aggressive-DOA was moderately correlated with higher center volume. Notably, Aggressive donor heart acceptance was not associated with worse 1-year survival, supporting broader donor utilization to expand HT access without compromising early recipient outcomes.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982562","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":"Pulmonary nontuberculous mycobacteria after lung transplantation: Pathogen or prognostic marker?","authors":"Arthur W Baker","doi":"10.1016/j.healun.2026.09.007","DOIUrl":"10.1016/j.healun.2026.09.007","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982543","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":"Investigating the impact of donor brain death duration on outcomes after lung transplant.","authors":"Alice J Coates, Samuel J Tingle, Dharesh Raj Amarnath, Georgios Kourounis, Andrew J Fisher, John H Dark","doi":"10.1016/j.healun.2026.09.006","DOIUrl":"10.1016/j.healun.2026.09.006","url":null,"abstract":"<p><strong>Background: </strong>Donor brain death induces haemodynamic and inflammatory changes that may influence organ quality and post-transplant outcomes. The impact of donor brain death duration on outcomes after lung transplantation remains uncertain.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the United Network for Organ Sharing database, including adult first-time lung transplant recipients from 2010 to December 2024. Donor brain death duration was defined as the interval between confirmation of donor brain death and donor cross-clamp. Missing data were addressed using multiple imputation. Multivariable Cox and logistic regression models assessed associations between brain death duration and post-transplant outcomes. Continuous variables were modeled using restricted cubic splines to preserve non-linear relationships.</p><p><strong>Results: </strong>About 31,178 patients were included. Median brain death duration was 49.8 hours (interquartile range 36.7-67.7). Longer brain death duration was independently associated with improved early outcomes, with a significant non-linear association with 90-day patient survival (p=0.004). A duration of 96 hours vs 24 hours was associated with improved 90-day patient survival (hazard ratio 0.73; 95% confidence interval 0.60-0.88). Similar associations were observed for 90-day graft survival. Longer duration was also associated with lower odds of 72-hour primary graft dysfunction (p=0.002) and 72-hour extracorporeal membrane oxygenation requirement (p<0.001). These associations were not sustained at 1 or 5 years.</p><p><strong>Conclusion: </strong>A longer duration between donor brain death and retrieval was associated with improved early outcomes, including lower 90-day patient mortality, without adverse long-term outcomes. These findings suggest that prolonged brain death duration alone should not negatively influence donor lung utilization decisions.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956085","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-to-midterm outcomes of lung transplantation following procurement with thoracoabdominal normothermic regional perfusion: An organ procurement and transplantation network analysis.","authors":"John W O'Neill, Paulo H P Gregorio, Aly S Hassaballa, Michael Z Mazur, Andres Bermudez, Thomas J Richards, Maria M Crespo, Christian A Bermudez","doi":"10.1016/j.healun.2026.09.005","DOIUrl":"10.1016/j.healun.2026.09.005","url":null,"abstract":"<p><strong>Introduction: </strong>The use of thoracoabdominal normothermic regional perfusion (TA-NRP) for organ procurement has rapidly increased in recent years. Although excellent posttransplant outcomes have been achieved using TA-NRP in cardiac and abdominal transplantation, there are concerns that peri-procedural changes during lung procurement may lead to inferior preservation and poorer lung transplant outcomes. To guide clinical practice, we evaluated early and mid-term lung transplant outcomes after procurement using TA-NRP.</p><p><strong>Methods: </strong>Using the UNOS/OPTN database, we conducted a retrospective analysis of lung transplants performed after controlled donation after circulatory death from 2020 through mid-2025. Recipients with lungs procured using TA-NRP were compared with recipients of lungs procured with standard rapid recovery (SRR).</p><p><strong>Results: </strong>We identified 1333 SRR and 253 TA-NRP lung donors and 1364 SRR and 261 TA-NRP lung transplant recipients. TA-NRP donors were younger (37.9 vs 41.0 years, p<0.001) and more often male (67.2% vs 56.7%, p=0.005) than the SRR donors. TA-NRP recipients required ventilation >48 hours less often (48% vs 56%, p=0.02) and had shorter hospital stays (21 vs 24 days, p=0.02), but adjustment for donor age, sex, geographic region, and year attenuated both differences while revealing lower odds of ECMO use at 72 hours in TA-NRP recipients (aOR 0.63, p=0.03). One- and 3-year survival were comparable between TA-NRP and SRR recipients, and neither concurrent heart procurement nor use of ex vivo lung perfusion affected lung allograft outcomes.</p><p><strong>Conclusion: </strong>Despite concerns of poorer outcomes after TA-NRP, short- and mid-term outcomes of lung transplant support the safety of this procurement technique.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956077","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":"Preoperative microaxial flow pump support and post-left ventricular assist device aortic insufficiency: Comprehensive sensitivity analyses confirm a robust and clinically meaningful association.","authors":"Jonathan Grinstein, Jennifer Cowger, Boaz Elad, Brian A Houston, Van-Khue Ton, Amy Fiedler, Aniket S Rali, Nir Uriel, Brandon Singletary, Ryan S Cantor, James K Kirklin, Francis D Pagani, Manreet K Kanwar","doi":"10.1016/j.healun.2026.08.025","DOIUrl":"10.1016/j.healun.2026.08.025","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955213","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":"Temporal trends in venoarterial extracorporeal membrane oxygenation and concurrent mechanical circulatory support for cardiogenic shock.","authors":"Christian Said, Jonas Sundermeyer, Jaime Hernandez-Montfort, Song Li, Rachna Kataria, Elric Zweck, Anthony Faugno, Shashank S Sinha, Jacob Abraham, Manreet K Kanwar, Arthur Reshad Garan, Van-Khue Ton, Claudius Mahr, Paavni Sangal, Peter Natov, M Imran Aslam, Pankaj Jain, Christopher Hayward, Daniel Burkhoff, Roberto Lorusso, Navin K Kapur","doi":"10.1016/j.healun.2026.09.003","DOIUrl":"10.1016/j.healun.2026.09.003","url":null,"abstract":"<p><strong>Background: </strong>Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often combined with other temporary mechanical circulatory support (tMCS) in cardiogenic shock, yet combination-specific outcomes remain poorly defined. We compared temporal trends, mortality, complications, and device sequencing across VA-ECMO strategies.</p><p><strong>Methods: </strong>VA-ECMO patients in the Cardiogenic Shock Working Group registry were analyzed. Patients were grouped as VA-ECMO alone or by first overlapping device: Impella CP, Impella 5.5, or intra-aortic balloon pump (IABP). The primary outcome was in-hospital mortality. Multivariable logistic regression assessed associations with mortality.</p><p><strong>Results: </strong>Of 11,386 cardiogenic shock patients, 1,502 (13.2%) received VA-ECMO, of whom 759 (50.5%) had concurrent tMCS [321 (21.4%) Impella CP, 208 (13.8%) Impella 5.5, and 230 (15.3%) IABP]. Concurrent Impella 5.5 was associated with lower mortality compared to VA-ECMO alone (aOR 0.62, 95% CI 0.45-0.86; p = 0.004); no significant difference was observed for Impella CP or IABP. Overall mortality was 48.4%, higher with acute myocardial infarction (AMI) than heart failure shock (58.7% vs 40.9%; p < 0.001). Across registry versions (2021-2025), isolated VA-ECMO use remained stable over time (45.0-48.9%; p for trend = 0.950), microaxial flow pump use increased (32.2% to 40.2%; p = 0.005), and IABP use declined (22.8% to 10.9%; p < 0.001). Anoxic brain injury was most strongly associated with mortality (aOR 10.51, 95% CI 6.26-17.64; p < 0.001).</p><p><strong>Conclusion: </strong>More than half of VA-ECMO patients received a concurrent device, with increasing microaxial flow pump and declining IABP use. Complications and mortality differed across strategies and shock etiologies.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944948","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 beating-heart transplantation after thoraco-abdominal normothermic regional perfusion in controlled donation after circulatory death donors.","authors":"Matteo Marro, Andrea Lechiancole, Erika Simonato, Giulia Agostini, Serena Franchetti, Laura Anna Stella, Antonio Loforte, Michele William La Torre, Mauro Rinaldi, Massimo Boffini, Igor Vendramin","doi":"10.1016/j.healun.2026.09.004","DOIUrl":"10.1016/j.healun.2026.09.004","url":null,"abstract":"<p><strong>Background: </strong>Heart transplantation from controlled donation after circulatory death expands the donor pool but exposes the graft to substantial ischemic injury. In Italy, the mandatory 20-minute no-touch period further prolongs warm ischemia. Thoraco-abdominal normothermic regional perfusion allows in situ graft recovery and assessment, while beating-heart implantation may avoid an additional ischemic injury.</p><p><strong>Methods: </strong>These case series included six consecutive recipients transplanted at two Italian centers between October 2025 and May 2026. All donor hearts underwent thoraco-abdominal normothermic regional perfusion, followed by beating-heart procurement and implantation with continuous normothermic coronary perfusion. Donor, procedural, and early postoperative outcomes were analyzed descriptively.</p><p><strong>Results: </strong>Median donor age was 61.5 years. Median functional warm ischemic time and total warm ischemic time were 38.5 and 46 min, respectively. Thoraco-abdominal normothermic regional perfusion restored satisfactory biventricular function in all donors, allowing successful graft assessment. Beating-heart procurement and implantation were completed in all recipients. Thirty-day patient and graft survival were 100%, and no recipient developed severe primary graft dysfunction requiring mechanical circulatory support within the first 72 h after transplantation. All recipients had preserved biventricular function at discharge.</p><p><strong>Conclusions: </strong>Heart transplantation after controlled donation after circulatory death using thoraco-abdominal normothermic regional perfusion and beating-heart implantation is feasible despite prolonged warm ischemic times mandated by Italian legislation. This ischemia-sparing strategy enables reliable graft assessment, avoids routine ex situ machine perfusion, and was associated with excellent early graft function and survival, supporting further evaluation in larger studies.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912161","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 missing dimensions in LVAD diffusion: Geographic access and medical therapy optimization.","authors":"Mehmet Cahit Sarıcaoğlu, Josef Stehlik, Ahmet Rüçhan Akar","doi":"10.1016/j.healun.2026.08.027","DOIUrl":"10.1016/j.healun.2026.08.027","url":null,"abstract":"<p><p>Despite major advances in durable left ventricular assist device (LVAD) technology, implantation volumes have remained relatively stagnant, and LVAD therapy has not entered mainstream cardiovascular practice. Recent work has framed this as a diffusion failure driven by delayed referral, uneven institutional learning, and economic and policy misalignment. We propose that two upstream, interacting determinants deserve greater attention: geographic access to advanced heart failure (HF) care and optimization of guideline-directed medical therapy (GDMT) before assessing eligibility for advanced therapies. Geography influences whether patients reach specialist care, receive contemporary GDMT, undergo timely reassessment, and remain connected to longitudinal LVAD follow-up. These gaps also complicate the denominator of \"LVAD-eligible\" patients: some may be under-referred despite refractory disease, whereas others may be undertreated before advanced therapy candidacy is established. National models further illustrate the distinction between adoption and equity. Türkiye experienced rapid expansion of durable mechanical circulatory support after reimbursement barriers were resolved in 2012, whereas the Kazakhstan model highlights coordinated national investment. Both demonstrate the importance of policy support, but neither national volume nor program growth alone establishes equitable geographic diffusion. Future registries and data reports should therefore integrate geographic and socioeconomic variables to distinguish LVAD underuse from structural under-access to optimal advanced HF care.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906094","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":"Beyond chronological age: Reconsidering pediatric donor hearts for adult transplantation.","authors":"Mônica Samuel Avila","doi":"10.1016/j.healun.2026.09.002","DOIUrl":"10.1016/j.healun.2026.09.002","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906055","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":"Heart transplant outcomes with use of pediatric donors for adult recipients: Insights from the International PGD Consortium.","authors":"Nitish K Dhingra, Victor J Leal, Marisa Signorile, Farid Foroutan, Laura Hastenteufel, Eduard Rodenas-Alesina, Chun-Po Steve Fan, Lauren Truby, Erik Henricksen, Sharon Chih, Marta Farrero Torres, Joan Guzman-Bofarull, Mercedes Rivas-Lasarte, Mario Sabatino, Luciano Potena, Joseph B Lerman, Adam D Devore, Jiho Han, Gene Kim, Maria G Crespo-Leiro, Roxana Moayedifar, David Couto Mallon, Helen Luikart, Javier Segovia, Koji Takeda, Shelley A Hall, Kiran K Khush, Andreas Zuckermann, Maryjane Farr, Archer K Martin, Filio Billia, Vivek Rao, Heather J Ross, Seyed Alireza Rabi, Yasbanoo Moayedi","doi":"10.1016/j.healun.2026.08.021","DOIUrl":"10.1016/j.healun.2026.08.021","url":null,"abstract":"<p><strong>Purpose: </strong>Donor age is a critical determinant of severe primary graft dysfunction (PGD) after heart transplant (HT), yet the safety and efficacy of using younger donor hearts for adult recipients remains incompletely characterized. Given ongoing organ shortages, an understanding of the relationship between pediatric donor age and post-transplant outcomes is essential to inform donor selection and optimize utilization.</p><p><strong>Methods: </strong>The International Consortium on PGD database retrospectively enrolled adult HT recipients and their donors from 14 centers across the United States, Canada, and Europe. In the present analysis, all adult recipients (≥18 years old) who underwent HT between 2010 and 2023 were included. The independent association of donor age with post-HT outcomes, including severe PGD and 1-year mortality, was evaluated using multivariable analysis accounting for predicted heart mass (PHM) ratio,recipient-donor age difference, geographical region, and recipient-donor sex match. Nonlinear associations of continuous covariates were assessed using restricted cubic splines.</p><p><strong>Results: </strong>Among 3787 HT recipients, pediatric donors <15 years accounted for 1.3%, while 5.0% were 15-18 years old. Recipients of pediatric donor hearts were slightly younger (donor age <15 years: 48±14; donor age 15-18: 51.3±14.1; donor age >18: 53.7±12.2 years), and were more likely to be of female sex (53.1% vs. 26.2% vs. 25.2%). While 7.64% of donors in North American centers were below the age of 18 years and 1.79% below the age of 15 years, these proportions were 3.6% and 0.25% in European centers. After multivariable analysis, donor age was independently associated with severe PGD (P = 0.006), with pediatric donor age conferring improved outcomes in spline analysis, but not 1-year mortality (P=0.156). Recipient-donor age difference showed a non-significant trend toward increased PGD risk at extreme age mismatches (P=0.056) and was not associated with mortality (P=0.88).</p><p><strong>Conclusions: </strong>Donor age demonstrates an independent association with severe PGD following adult heart transplantation. Pediatric donor age confers progressively lower risk, with equivalent survival at 1 year. These findings suggest that carefully selected younger donor hearts can be used safely and support consideration of donor age as a continuous risk factor, rather than reliance on arbitrary thresholds in clinical decision-making.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891755","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}