Journal of Heart and Lung Transplantation最新文献

{"title":"Pump exchange for major device related infection in patients receiving a durable left ventricular assist device.","authors":"Sophie R Persaud, Michael Pienta, Donald S Likosky, Francis D Pagani","doi":"10.1016/j.healun.2024.11.032","DOIUrl":"10.1016/j.healun.2024.11.032","url":null,"abstract":"<p><strong>Background: </strong>Device-related infection (DRI) remains a cause of morbidity and mortality following durable left ventricular assist device (dLVAD) implantation. We evaluated outcomes following pump exchange (PE) for DRI following dLVAD implantation.</p><p><strong>Methods: </strong>Forty-nine patients underwent PE between 1/2007 and 12/2022 for major DRI. Outcomes included survival, incidence of subsequent DRI, and proportion of patients achieving success (freedom from DRI at 1-year following PE).</p><p><strong>Results: </strong>Median age was 49 years. Median time from primary implant to DRI diagnosis and from diagnosis to PE was 26 and 4.1 months, respectively. Median time to DRI recurrence was 5.8 months with 76% of patients achieving success. Success was obtained in 23/24 (96%) of patients whose time to PE from DRI diagnosis was ≤4 months and 14/25 (56%) if time >4 months.</p><p><strong>Conclusion: </strong>Most patients achieve success following PE for DRI. The risk of subsequent DRI and mortality remains high. Early (≤4 months) PE following DRI diagnosis increases the likelihood of success, while reducing the rate of subsequent DRI.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791942","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":"Refining the Gold Standard: Volume Calibration Methods for Right Ventricular Pressure-Volume Loops.","authors":"Brian A Houston","doi":"10.1016/j.healun.2024.11.034","DOIUrl":"https://doi.org/10.1016/j.healun.2024.11.034","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791955","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":"Basiliximab induction immunosuppression and lung transplant outcomes: Propensity analysis in a multicenter cohort.","authors":"Jeeyon G Rim, Anne S Hellkamp, Megan L Neely, John M Reynolds, John A Belperio, Marie Budev, Lerin Eason, Courtney W Frankel, Shaf Keshavjee, Jerry Kirchner, Lianne G Singer, Pali D Shah, Laurie D Snyder, S Samuel Weigt, Scott M Palmer, Jamie L Todd","doi":"10.1016/j.healun.2024.11.033","DOIUrl":"10.1016/j.healun.2024.11.033","url":null,"abstract":"<p><strong>Background: </strong>Basiliximab induction immunosuppression is increasingly employed in lung transplant recipients despite limited prospective evidence to support its use in this population. We sought to determine the relationship between basiliximab induction and development of acute rejection, chronic lung allograft dysfunction, and other clinically relevant outcomes in a multicenter lung transplant cohort with variable induction practice patterns.</p><p><strong>Methods: </strong>We applied propensity-based statistical methods to rigorous, prospectively collected longitudinal data from 768 newly transplanted adult lung recipients at 5 North American centers (368 who received basiliximab induction immunosuppression and 400 who received no induction immunosuppression). Treatment effects were estimated using outcome-specific propensity score regression models, weighted by the outcome-specific overlap weights, and stratified by center strata.</p><p><strong>Results: </strong>Basiliximab induction immunosuppression was associated with a significant reduction in any grade acute rejection (HR 0.65, 95% CI 0.46-0.92; p=0.015), organizing pneumonia histology (HR 0.38, 95% CI 0.16-0.90; p=0.028), acute lung injury histology (HR 0.28, 95% CI 0.13-0.61; p=0.001), and development of class II donor specific antibodies (HR 0.51, 95% CI 0.27-0.95; p=0.034) within the first posttransplant year. However, there was no significant association between basiliximab and development of chronic lung allograft dysfunction, mortality, or graft loss. For select infections during the first posttransplant year, there was no evidence of a difference in risk between patients who did versus did not receive basiliximab.</p><p><strong>Conclusions: </strong>Basiliximab induction immunosuppression is associated with a significant reduction in early posttransplant cellular and humoral immune events and lung injury histologies but not chronic lung allograft dysfunction or mortality.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791973","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 prognostic value of single and repeated ≥10% FEV₁ declines for chronic lung allograft dysfunction.","authors":"Kimberly Lu, Miranda C Bradford, Xuanshuang Wang, Ted Liu, Chelsea Schmitz, Erika D Lease, Siddhartha Kapnadak, Ramsey Hachem, Kathleen J Ramos, Eric D Morrell","doi":"10.1016/j.healun.2024.11.031","DOIUrl":"10.1016/j.healun.2024.11.031","url":null,"abstract":"<p><p>There is a paucity of data reporting the positive and negative predictive values (PPV, NPV) of acute declines in lung function on chronic lung allograft dysfunction (CLAD). We sought to define the predictive ability of single or repeated forced expiratory volume in the first second (FEV₁) declines for at least 3 weeks on the development of CLAD or death by 1-year. We analyzed 340 subjects with at least 3 years of follow-up data from two lung transplant centers. A single ≥10% FEV₁ decline had a PPV of 35% and NPV of 63%, and a repeated ≥10% FEV₁ decline for at least 3 weeks had a PPV of 44% and NPV of 65%. Notably, the proportion of individuals with incipient CLAD at the time of a single or repeated ≥20% FEV1 decline was 50% and 71%, respectively. These estimates could inform the development of acute lung allograft dysfunction FEV₁ thresholds as enrollment criteria or surrogate outcome measures.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785765","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 cardiopulmonary resuscitation on donation after circulatory death heart transplantation: A United Network for Organ Sharing registry analysis.","authors":"Nidhi Iyanna, Umar Nasim, Ander Dorken-Gallastegi, Nicholas R Hess, Mohamed Abdullah, Gavin W Hickey, Mary E Keebler, Edward T Horn, Yeahwa Hong, David J Kaczorowski","doi":"10.1016/j.healun.2024.11.024","DOIUrl":"10.1016/j.healun.2024.11.024","url":null,"abstract":"<p><strong>Background: </strong>The criteria for evaluating donations after circulatory death (DCD) heart allografts, particularly donor cardiopulmonary resuscitation (CPR) status, remains underexplored. This study evaluates the impact of donor CPR on post-transplant outcomes in DCD heart transplants.</p><p><strong>Methods: </strong>The UNOS registry was queried to analyze adult recipients who underwent DCD heart transplantation between 1/1/2019 and 3/31/2023, with a 1-year follow-up period extending to 3/31/2024. Primary outcomes were 90-day and 1-year post-transplant survival. 1:1 propensity score-matching was performed. Restricted cubic spline was used to model duration of CPR and likelihood of 1-year post-transplant mortality. Sub-analysis was performed to evaluate the effects of CPR duration on donor heart utilization.</p><p><strong>Results: </strong>A total of 683 DCD recipients were included, and 378 recipients (55.3%) received hearts from donors that underwent CPR. Recipients with donors who received CPR had similar 1-year (92.1% vs 90.7%) post-transplant survival compared to recipients with donors who did not receive CPR. The comparable post-transplant survival persisted in a propensity score-matched comparison. The spline model demonstrated that longer duration of CPR was not associated with lower odds of 1-year post-transplant survival compared to the reference of 15 minutes. In the sub-analysis, longer CPR duration was not significantly associated with reduced donor heart utilization.</p><p><strong>Conclusions: </strong>Donors that received CPR requires consideration for DCD transplants since damage during cardiac arrest prior to withdrawal of life support may amplify warm ischemic injury during procurement. This study suggests that the use of DCD hearts that underwent CPR can expand the donor pool without compromising early post-transplant survival.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755104","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":"Severe primary graft dysfunction in heart transplant recipients using donor hearts after circulatory death: United States experience.","authors":"Peter D Cho, Samuel T Kim, Hedwig Zappacosta, John P White, Stephanie McKay, Reshma Biniwale, Abbas Ardehali","doi":"10.1016/j.healun.2024.11.027","DOIUrl":"10.1016/j.healun.2024.11.027","url":null,"abstract":"<p><strong>Objective: </strong>This study compares the incidence of severe Primary Graft Dysfunction (PGD) in a contemporaneous cohort of donors after circulatory death (DCD) and brain death (DBD) heart transplant recipients.</p><p><strong>Method: </strong>The United Network for Organ Sharing database was queried for isolated adult heart transplant recipients from 9/2023 to 6/2024. Heart recipients were stratified based on the organ donation type (DCD vs DBD). DCD heart recipients were further categorized based on the procurement method: time between circulatory death to cross-clamp: ≤ 30 minutes (Direct Procurement and Preservation, DPP), >30 minutes (Normothermic Regional Perfusion, NRP). Outcomes of interest included: severe PGD (Left/Bi-Ventricular; LV/BiV) at 24 hours and Severe Graft Dysfunction at 72 hours (patients with severe PGD at 24 hours that remain on mechanical support at 72 hours).</p><p><strong>Results: </strong>A total of 2590 adult heart transplant recipients were identified, of which 17.1% underwent DCD heart transplantation. DCD heart recipients were less likely to be on inotrope (36.7% vs 41.6%, p=0.046) and ECMO (4.1% vs 9.9%, p<0.001) prior to transplant than DBD heart recipients. DCD heart recipients were more likely than DBD heart recipients to develop severe PGD (LV/BiV) at 24 hours (9.5% vs 5.1%, p<0.001). The Severe Graft Dysfunction at 72 hours (2.3% vs 2.9%, p=0.67) and 30-day mortality were similar between the 2 groups. Recipients of DCD heart procured with DPP or NRP had similar severe PGD (LV/BiV) at 24 hours (9.4% vs 9.7%, p=0.93).</p><p><strong>Conclusion: </strong>Severe PGD at 24 hours is higher among the DCD than DBD heart recipients, but Graft Dysfunction improves by 72 hours.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755121","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":"Maribavir for refractory cytomegalovirus infection (with or without resistance) in solid organ transplant recipients: subgroup analysis of the phase 3 randomized SOLSTICE study.","authors":"Emily A Blumberg, Oliver Witzke, Mark Harber Mbbs, Michael G Ison, Faouzi Saliba, Nassim Kamar, Aimee K Sundberg, Joan Gu, Deepali Kumar, Ricardo M La Hoz","doi":"10.1016/j.healun.2024.11.026","DOIUrl":"https://doi.org/10.1016/j.healun.2024.11.026","url":null,"abstract":"<p><strong>Background: </strong>In the phase 3 SOLSTICE study (NCT02931539), maribavir was superior to investigator-assigned therapy (IAT) for confirmed cytomegalovirus viremia clearance at study week 8 in hematopoietic cell/solid organ transplant (HCT/SOT) recipients. We report additional efficacy and safety analyses from the SOT subgroup.</p><p><strong>Methods: </strong>Eligible solid organ transplant recipients (n=211) received maribavir 400 mg twice daily (n=142) or IAT (n=69) for 8 weeks (12 weeks' follow-up). Cytomegalovirus viremia clearance at week 8 (primary endpoint) and cytomegalovirus viremia clearance plus symptom control at the end of week 8 maintained through week 16 (key secondary endpoint) were assessed. Graft outcomes and treatment-emergent adverse events were analyzed.</p><p><strong>Results: </strong>A higher proportion maribavir-treated patients achieved the primary endpoint than with IAT across transplant organ types, including kidney (maribavir: 59.5%, IAT: 34.4%), lung (47.5%, 13.6%), and heart (42.9%, 11.1%). Similar proportions of patients achieved the key secondary endpoint in both arms (13.4% versus 11.6%; adjusted difference: 2.4%; 95% CI: -7.05, 11.83%; p=0.620). Rates of treatment-emergent adverse events were: maribavir (96.5%), IAT (88.4%). Maribavir (3.5%) had fewer treatment discontinuations due to treatment-emergent adverse events than IAT (23.2%). There were no graft losses; patients in both arms experienced acute rejection (maribavir: 9 [6.3%]; IAT: 4 [5.8%]). Treatment-emergent maribavir mutations occurred in 28.2% of patients; 19/33 patients achieved viremia clearance with subsequent alternative treatment.</p><p><strong>Conclusions: </strong>Consistent with findings in the overall SOLSTICE population, this subgroup analysis of SOT recipients demonstrated greater effectiveness of maribavir for cytomegalovirus viremia clearance and fewer discontinuations due to treatment-emergent adverse events than IAT.</p><p><strong>Clinical trial registration number: </strong>ClinicalTrials.gov; NCT02931539 DATA AVAILABILITY STATEMENT: The datasets, including the redacted study protocol, redacted statistical analysis plan, and individual participants data supporting the results reported in this article, will be made available within three months from initial request, to researchers who provide a methodologically sound proposal. The data will be provided after its deidentification, in compliance with applicable privacy laws, data protection and requirements for consent and anonymization.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755118","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":"High-dimensional tissue profiling of immune cell responses in chronic lung allograft dysfunction.","authors":"Saskia Bos, Bethany Hunter, David McDonald, George Merces, Georgia Sheldon, Pauline Pradère, Joaquim Majo, Julian Pulle, Arno Vanstapel, Bart M Vanaudenaerde, Robin Vos, Andrew J Filby, Andrew J Fisher","doi":"10.1016/j.healun.2024.11.021","DOIUrl":"10.1016/j.healun.2024.11.021","url":null,"abstract":"<p><strong>Purpose: </strong>The immunological drivers of chronic lung allograft dysfunction (CLAD), the major barrier to long-term survival after lung transplantation, are poorly understood at a tissue level. Tissue imaging using mass spectrometry with laser ablation of regions of interest offers single-cell resolution of distinct immune cell populations and their spatial relationships and may improve our understanding of CLAD pathophysiology.</p><p><strong>Methods: </strong>Lung tissue from 23 lung transplant recipients, 20 with and 3 without CLAD, was sectioned and stained with a 40-plex antibody panel before 81 regions of interest from airways, blood vessels and lung parenchyma were laser ablated.</p><p><strong>Results: </strong>190,851 individual segmented cells across 41 mm² tissue were captured before 26 distinct immune and structural cell populations were identified and interrogated across CLAD phenotypes. CLAD was associated with expansion of cytotoxic T cells, γδ T cells and plasma cells and M2 macrophage polarization compared with non-CLAD. Within CLAD, bronchiolitis obliterans syndrome was characterized by more γδ T cells and fewer Th1 cells than restrictive allograft syndrome. Both adaptive and innate immune cells were involved in the temporal evolution of fibrotic remodeling. Although fibrosis seemed to be partially associated with different factors in restrictive allograft syndrome (M2 macrophages, Th1 cells) and in bronchiolitis obliterans syndrome (γδ T cells).</p><p><strong>Conclusion: </strong>Imaging mass cytometry enables in-depth analyses of immune cell phenotypes in their local microenvironment. Using this approach, we identified major differences in cell populations in CLAD versus non-CLAD and in BOS versus RAS, with novel insights into the fibrotic progression of CLAD.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750976","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":"Waitlist mortality for patients with cardiac allograft vasculopathy under the 2018 OPTN donor heart allocation system.","authors":"Bernard S Kadosh, Suhani S Patel, Sharnendra K Sidhu, Allan B Massie, Stephanie Golob, Randal I Goldberg, Alex Reyentovich, Nader Moazami","doi":"10.1016/j.healun.2024.11.016","DOIUrl":"10.1016/j.healun.2024.11.016","url":null,"abstract":"<p><strong>Background: </strong>In the 2018 Organ Procurement and Transplantation Network donor heart allocation system, patients listed for re-transplantation due to cardiac allograft vasculopathy (CAV) are assigned to Status 4 unless hemodynamic criteria are met. We aim to examine waitlist outcomes of CAV patients among adult heart transplant candidates.</p><p><strong>Methods: </strong>We examined waitlist mortality stratified by CAV and waitlist status among adult heart transplant candidates using Scientific Registry of Transplant Recipients data from 10/1/2018-11/1/2023. We analyzed waitlist mortality using Kaplan-Meier curves and doubly-robust Cox regressions adjusted for age, gender, sex, race, and dialysis. We compared CAV to non-CAV patients by initial waitlist status, first status of interest, and time-dependent status.</p><p><strong>Results: </strong>Of 21,586 listed patients, 368 were listed for CAV. CAV patients were most often listed at Status 4 with lower proportions at Status 3/2/1 compared with non-CAV patients. Status 4 and Status 3 CAV candidates demonstrated higher than expected waitlist mortality compared to non-CAV counterparts (Status 4: HR 0.51, 95% CI 0.31-0.84; p < 0.01; Status 3: HR 0.61, 95% CI 0.23-1.64; p = 0.33) with similar mortality to non-CAV patients in Status 3 and 2, respectively (Status 4: HR 0.80, 95% CI 0.48-1.35; p = 0.4; Status 3: HR 1.07, 95% CI 0.40-2.86; p = 0.89). When stratifying by status tier, CAV waitlist patients ever listed at Status 4 and 3 had a higher probability of death compared to their non-CAV counterparts (Status 4: HR 1.99, 95% CI 1.20-3.31, p < 0.01; Status 3: HR 3.06, 95% CI 1.06-8.87, p = 0.04).</p><p><strong>Conclusions: </strong>After 2018, CAV patients had a higher risk of waitlist mortality at Status 4 and 3 compared to non-CAV patients. These results suggest that CAV patients are underprioritized in the current allocation system.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739603","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":"Chronic Thromboembolic Pulmonary Hypertension and Cancer: a true relationship, but one likely beyond coagulation.","authors":"Christian Gerges, Irene M Lang","doi":"10.1016/j.healun.2024.11.025","DOIUrl":"10.1016/j.healun.2024.11.025","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716332","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}