Journal of Heart and Lung Transplantation最新文献

{"title":"A familiar drug in unfamiliar territory: Will we manage to repurpose SGLT2 inhibitors in pulmonary arterial hypertension?","authors":"Daniel A Jeffery, Mark Toshner, Joanna Pepke-Zaba","doi":"10.1016/j.healun.2026.08.020","DOIUrl":"10.1016/j.healun.2026.08.020","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887669","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":"Donor type and organ preservation in heart transplantation: Association with recovery following severe primary graft dysfunction.","authors":"Haoran Jiang, Isaac S Alderete, Joseph B Lerman, Chetan B Patel, Adam D DeVore, Jacob N Schroder, Carmelo A Milano, Jeffrey E Keenan, Oliver K Jawitz","doi":"10.1016/j.healun.2026.08.019","DOIUrl":"10.1016/j.healun.2026.08.019","url":null,"abstract":"<p><strong>Background: </strong>Primary graft dysfunction (PGD) remains a major cause of post-heart transplant morbidity and mortality. Prior studies have focused on predictors of developing PGD. Less is known about factors associated with post-PGD recovery.</p><p><strong>Methods: </strong>We queried the Scientific Registry of Transplant Recipients for adult heart transplants between September 2023 and December 2025. Severe PGD was defined as dependence on new extracorporeal membrane oxygenation or ventricular assist device support at 24 h post-transplant. Outcomes were compared across donor type (donation after circulatory death [DCD] vs donation after brain death [DBD]) and procurement/preservation strategies (normothermic regional perfusion (NRP), ex-vivo heart perfusion (EVP), static cold storage). The primary outcome was overall survival. Secondary outcomes included graft failure and 30-day survival. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding.</p><p><strong>Results: </strong>Among 7059 heart transplant recipients, 462 (6.5%) developed severe PGD, which was associated with significantly worse survival. Among patients with severe PGD, DCD recipients had higher unadjusted survival compared with DBD (1-year survival 84.1% vs. 65.1% [log-rank P=0.001]). In IPTW-adjusted analyses DCD transplants were associated with improved survival (adjusted hazard ratio, 0.44; 95% CI, 0.23-0.85; P=0.014). Preservation strategy was not associated with survival after adjustment. DCD was associated with higher odds of 30-day survival in unadjusted analyses.</p><p><strong>Conclusion: </strong>Compared with DBD, DCD recipients with severe PGD demonstrated improved survival. Preservation strategy was not independently associated with survival, though subgroup analyses were limited by small numbers. Among predictors of early recovery, ventricular support devices at 24 h were independently associated with lower odds of 30-day survival compared with ECMO.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880784","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 cold truth: Myocardial temperatures and graft function achieved with cold static storage.","authors":"Nina Uzoigwe, Caroline A Magro, Katherine G Phillips, Kelly Drozdowicz, Marzia Leacche, Les James, Akshay Kumar, Randal Goldberg, Alexander Reyentovich, Deane Smith, Nader Moazami","doi":"10.1016/j.healun.2026.08.018","DOIUrl":"10.1016/j.healun.2026.08.018","url":null,"abstract":"<p><p>We aimed to investigate myocardial temperatures of allografts after removal from cold static storage (CSS) and the relationship between temperature and early outcomes of heart transplantation (HT). Between January and September 2024, 22 allografts preserved with CSS underwent prospective temperature measurements at the left ventricular free wall (LVFW) and interventricular septum; preservation solution temperatures were also measured. Median LVFW temperature was 4.0°C, septal temperature was 3.9°C, and solution temperature was 3.7°C. LVFW and septal temperatures were significantly correlated (p < 0.001), as were septal and solution temperatures (p = 0.03). Ischemic time inversely correlated with solution temperature (p = 0.021), and septal thickness correlated with septal temperature (p = 0.04). One patient developed severe primary graft dysfunction, and 30-day recipient and graft survival were 100% (22/22). We conclude that CSS maintains myocardial temperatures near 4°C, and it can achieve excellent post-HT outcomes with a low incidence of PGD.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874518","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 pulmonary isolation of non-tuberculous mycobacterial organisms is associated with increased risk of death and chronic lung allograft dysfunction: A Lung Transplant Outcomes Group Cohort Study.","authors":"Gabrielle Mezochow, Stephen Griffiths, Douglas E Schaubel, Michelle Oyster, Laurel Kalman, Alyssa Mezochow, Emily Blumberg, Gina Hong, Denis Hadjiliadis, Krishna Pandya, Tamara Claridge, Stephanie Witek, Luke Benvenuto, Dennis Lyu, Michael P Combs, Pali Shah, Christian Merlo, Aida Venado Estrada, Jonathan P Singer, Scott Palmer, Jason D Christie, Michaela R Anderson","doi":"10.1016/j.healun.2026.08.017","DOIUrl":"10.1016/j.healun.2026.08.017","url":null,"abstract":"<p><strong>Background: </strong>How pulmonary non-tuberculous mycobacteria (NTM) impact lung transplant outcomes is unknown. We evaluated the effect of pulmonary isolation of NTM on death or re-transplantation and chronic lung allograft dysfunction (CLAD).</p><p><strong>Methods: </strong>We performed a multicenter cohort study of adult lung transplant recipients at five US centers from 2007 to 2022. Our exposure was growth of NTM from pulmonary samples in the first year post-transplant (\"early\") in primary analyses, and growth at any time post-transplant in secondary analyses. We evaluated time from transplantation to death or re-transplantation and CLAD using separate covariate-adjusted proportional hazards models, each with a time-dependent exposure indicator for early first pulmonary NTM isolation.</p><p><strong>Results: </strong>Of 1,766 lung transplant recipients, 223 (13%) had early pulmonary NTM isolation. NTM was first isolated at a median [interquartile range] of 61 [17-158] days after transplantation. Early NTM growth was associated with increased risk of death or re-transplantation (HR 1.30, 95% CI 1.05-1.60), driven by rapid growing NTM (HR 2.17, 95% CI 1.42-3.31). Early growth of NTM was associated with increased risk of CLAD (HR 1.29, 95% CI 1.03-1.62); this association was driven by slow growing NTM (HR 1.33, 95% CI 1.04-1.69). Association appeared modified by acute cellular rejection (p = 0.10) and pre-operative diagnosis (p = 0.04), with a stronger association in recipients with ILD (HR 1.67, 95% CI 1.26-2.20). Similar associations were present for NTM growth at any time post-transplant.</p><p><strong>Conclusions: </strong>Pulmonary growth of NTM in the first post-transplant year occurred frequently and was associated with increased risk of death or re-transplantation and CLAD.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865441","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":"Re-evaluating the role of oxygen delivery and radiographs in the definition of primary graft dysfunction after lung transplantation: A Lung Transplant Outcomes Group cohort study.","authors":"Michaela R Anderson, Robert Gallop, A Russell Localio, Michelle Oyster, Laurel Kalman, Stephen Griffiths, Matthew Hartwig, Laurie D Snyder, Michael Shashaty, Vivek Ahya, Maria Crespo, Mauer Biscotti, Gabrielle Mezochow, Krishna Pandya, Julia Gasior, Daniel Calabrese, John R Greenland, Luke Benvenuto, Gundeep Dhillon, Michael P Combs, John McDyer, Chadi Hage, David Roe, Pali Shah, Christian Merlo, Jonathan P Singer, Scott M Palmer, Jason D Christie","doi":"10.1016/j.healun.2026.08.016","DOIUrl":"10.1016/j.healun.2026.08.016","url":null,"abstract":"<p><strong>Background: </strong>Primary graft dysfunction (PGD) is severe lung injury following lung transplantation. Variable radiograph interpretation and changes in mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support for hypoxemia may limit the current PGD definition's validity.</p><p><strong>Methods: </strong>We assessed whether changes in the PGD definition accounting for oxygen delivery method (intubated, non-intubated, ECMO) were associated with differential graft survival. Severe PGD was grade 3 at 48 or 72 hours after transplant. We estimated crude and standardized time from transplantation to death or retransplantation with each alternate defining criterion. We secondarily evaluated whether excluding chest radiography led to severe PGD re-classification.</p><p><strong>Results: </strong>Among 3,170 recipients, 749 (24%) had severe PGD by current definition. By revised oxygen delivery definition, 182 non-intubated recipients and 372 intubated recipients had severe PGD, and 177 recipients had severe PGD requiring ECMO. Recipients with severe PGD requiring ECMO had the highest 1-year mortality (cumulative incidence of death 0.20, 95%CI 0.17-0.24), followed by intubated severe PGD (0.15, 95%CI 0.13-0.17). Non-intubated recipients had similar mortality with and without severe PGD (non-intubated with PGD: 1-year cumulative incidence of death 0.11, 95%CI 0.09-0.13; non-intubated without severe PGD: 0.10, 95%CI 0.09-0.11). Exclusion of radiographs reclassified 814 recipients, including 89 (11%) reclassified as severe PGD. On review of radiographs from recipients reclassified as severe PGD, the most frequent findings were effusions, atelectasis, and pneumonia.</p><p><strong>Conclusion: </strong>A revised PGD definition stratified by mode of oxygen delivery identifies groups with differential mortality. Chest radiography is critical to excluding alternative causes of lung injury in recipients with severe hypoxemia.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865367","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 Donor-Specific Antibodies: Molecular Characterization of Antibody-Mediated Rejection Using Tissue-Based Transcriptomics in Heart Transplantation.","authors":"Andrea Fernandez Valledor, Julia Baranowska, Adi Hertz, Cathrine M Moeller, Salwa Rahman, Daniel Oren, David Bae, Marta Farrero, Ana Garcia Alvarez, Dor Lotan, Justin Fried, Jayant Raihkelhar, Ersilia M DeFilippis, Koji Takeda, Farhana Latif, David T Majure, Kevin J Clerkin, Gabriel T Sayer, Nir Uriel","doi":"10.1016/j.healun.2026.08.015","DOIUrl":"10.1016/j.healun.2026.08.015","url":null,"abstract":"<p><strong>Background: </strong>Antibody-mediated rejection (AMR) contributes to graft dysfunction after heart transplantation, yet histopathology and circulating donor-specific antibodies (DSA) may incompletely capture intragraft biology. We characterized molecular ABMR by human leukocyte antigen (HLA)-DSA status and, within DSA-negative cases, non-HLA antibody status.</p><p><strong>Methods: </strong>We analyzed 579 for-cause endomyocardial biopsies with paired Molecular Microscope Diagnostic System (MMDx) and histopathology. Molecular scores, transcripts, donor-derived cell-free DNA (dd-cfDNA), and gene-expression profiling (GEP) were compared using patient-clustered models with false-discovery-rate correction. Multivariable Cox models evaluated a 2-year composite of death, retransplantation, graft dysfunction (LVEF < 50%), or subsequent histologic rejection (acute cellular rejection [ACR] ≥ 1B/2R or pAMR ≥ 1).</p><p><strong>Results: </strong>MMDx-defined ABMR was present in 83 biopsies (14.3%); 30 (36.1%) were DSA-negative. DSA-negative and DSA-positive ABMR had similar ABMR probabilities (0.66 vs 0.66), global rejection scores, dd-cfDNA (0.83% vs 0.63%), GEP (35 vs 33), and transcriptomic profiles. Within DSA-negative ABMR, non-HLA antibodies were detected in 20/30 (66.7%) and associated with higher ABMR probability (0.69 vs 0.63; p = 0.041), dd-cfDNA (0.91% vs 0.62%; p = 0.048), GEP (35 vs 33; p = 0.019), and greater endothelial, ABMR/NK-cell, interferon-γ, and injury-related transcript activation. Histologic-molecular agreement was limited (κ = 0.14); 70/83 molecular ABMR biopsies lacked histologic pAMR. In joint models, molecular ABMR, but not pAMR, was associated with higher dd-cfDNA (b = 0.38%, p = 0.039). Conversely, histologic pAMR independently predicted the composite outcome (adjusted HR 2.68, 95% CI 1.34-5.35; p = 0.005), whereas molecular ABMR did not (adjusted HR 0.93, 95% CI 0.56-1.56; p = 0.795).</p><p><strong>Conclusions: </strong>Molecular ABMR exhibited similar profiles regardless of HLA-DSA status. Non-HLA antibodies identified greater activation and dd-cfDNA levels within DSA-negative ABMR. Molecular assessment may complement conventional evaluation by refining ABMR phenotyping.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865388","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":"Dapagliflozin in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: The DAPAH randomized controlled trial.","authors":"Mads Kristian Ersbøll, Jesper Kjærgaard, Karin Waidtløw, Lars Køber, Finn Gustafsson, David G Kiely, David Montani, Jørn Carlsen, Kasper Rossing","doi":"10.1016/j.healun.2026.07.008","DOIUrl":"https://doi.org/10.1016/j.healun.2026.07.008","url":null,"abstract":"<p><strong>Background: </strong>SGLT2 inhibitors (SGLT2i) reduce mortality in left heart failure. In pulmonary arterial hypertension (PAH), preclinical data suggest SGLT2i improve right ventricular function through metabolic modulation and inhibition of vascular remodeling via smooth muscle cell pathways. The DAPAH trial evaluated whether the potential benefits of SGLT2 inhibition translate into clinical efficacy for symptomatic patients on background vasodilator therapy with either PAH or chronic thromboembolic pulmonary hypertension.</p><p><strong>Methods: </strong>In this single-center, double-blind trial, 52 patients were randomized (1:1) to dapagliflozin 10 mg daily or placebo for 12 weeks. The primary endpoint was change in Peak VO₂. Secondary endpoints included invasive hemodynamics, NT-proBNP, 6-minute walk distance (6MWD) and REVEAL Lite 2 scores.</p><p><strong>Results: </strong>Baseline characteristics were balanced (n=52; mean age 66.5 years; 63% female; n=40 PAH, n=12 CTEPH). Fifty-one patients had complete data on Peak VO₂. At 12 weeks, there was no significant difference in Peak VO₂ (Adjusted Mean Difference: -0.67 mL/kg/min; 95% CI [-1.67, 0.33]; p=0.187). No significant treatment effects were observed for pulmonary vascular resistance (p=0.255), 6MWD (p=0.22), or NT-proBNP trajectory (interaction p=0.681). REVEAL Lite 2 scores showed a small reduction with dapagliflozin (-0.66; 95% CI [-1.25, -0.06]; p=0.031). Metabolic target engagement was evident from a significant reduction in serum urate (P-interaction < 0.001). Dapagliflozin was safe and well-tolerated.</p><p><strong>Conclusion: </strong>This randomized study of SGLT2i in pre-capillary PH showed that 12 weeks of dapagliflozin did not significantly improve exercise capacity, hemodynamics, or functional status compared to placebo.</p><p><strong>Clinicaltrials: </strong>gov (NCT05179356).</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865410","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":"Measles and varicella protection - surge in cases, but now a surge in hope!","authors":"Robert J Rolfe, Cameron R Wolfe","doi":"10.1016/j.healun.2026.08.013","DOIUrl":"10.1016/j.healun.2026.08.013","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818656","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":"Daratumumab to treat antibody mediated rejection in the absence of donor specific antibodies: Do we need an update in our vocabulary or mental model?","authors":"Jonathan J Edwards, Joseph W Rossano","doi":"10.1016/j.healun.2026.08.012","DOIUrl":"10.1016/j.healun.2026.08.012","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818623","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":"Procurement without borders: Quality, access, and financial fairness in the era of heart organ procurement services.","authors":"Igor Gosev, Matthew Montgomery","doi":"10.1016/j.healun.2026.08.009","DOIUrl":"10.1016/j.healun.2026.08.009","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794119","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}