Journal of Heart and Lung Transplantation最新文献

{"title":"Three-year outcomes after bridge to transplantation ECMO—pre- and post-2018 UNOS revised heart allocation system","authors":"Het Patel MBBS , Leonie Dupuis MD , Matthew Bacchetta MD, MBA, MA , Antonio Hernandez MD , Manreet K. Kanwar MD , JoAnn Lindenfeld MD , Zubair Shah MD , Hasan K. Siddiqi MD, MSCR , Shashank S. Sinha MD , Ashish S. Shah MD , Kelly H. Schlendorf MD, MHS , Aniket S. Rali MD, FACC","doi":"10.1016/j.healun.2024.07.025","DOIUrl":"10.1016/j.healun.2024.07.025","url":null,"abstract":"<div><h3>Background</h3><div>Utilization of temporary mechanical circulatory support, including veno-arterial extra-corporeal membrane oxygenation as a bridge to heart transplantation (HT) has increased significantly under the revised United Network for Organ Sharing (UNOS) donor heart allocation system. The revised heart allocation system aimed to lower waitlist times and mortality for the most critically ill patients requiring biventricular, nondischargeable, mechanical circulatory support. While previous reports have shown improved 1-year post-HT survival in the current era, 3-year survival and factors associated with mortality among bridge-to-transplant (BTT) extra-corporeal membrane oxygenation (ECMO) patients are not well described.</div></div><div><h3>Methods</h3><div>We queried the UNOS database for all adult (age ≥ 18 years) heart-only transplants performed between 2010 and 2019. Patients were stratified as either pre- (January 2010-September 2018; era 1) or post-allocation change (November 2018-December 2019; era 2) cohort based on their HT date. Baseline recipient characteristics and post-transplant outcomes were compared. A Cox regression analysis was performed to explore risk factors for 3-year mortality among BTT-ECMO patients in era 2. For each era, 3-year mortality was also compared between BTT ECMO patients and those transplanted without ECMO support.</div></div><div><h3>Results</h3><div>During the study period, 116 patients were BTT ECMO during era 1 and 154 patients during era 2. Baseline recipient characteristics were similar in both groups. Median age was 48 (36-58 interquartile range (IQR)) years in era 2, while it was 51 (27-58 IQR) years in era 1. The majority of BTT-ECMO patients were males in both era 2 and era 1 (77.7% vs 71.5%, <em>p</em> = 0.28). Median ECMO run times while listed for HT were significantly shorter (4 days vs 7 days, <em>p</em> < 0.001) in era 2. Waitlist mortality among BTT ECMO patients was also significantly lower in era 2 (6.3% vs 19.3%, <em>p</em> < 0.001). Post-HT survival at 6 months (94.2% vs 75.9%, <em>p</em> < 0.001), 1 year (90.3% vs 74.2%, <em>p</em> < 0.001), and 3 years (87% vs 66.4%, <em>p</em> < 0.001) was significantly improved in era 2 as compared to era 1. Graft failure at 1 year (10.3% vs 25.8%, <em>p</em> = 0.0006) and 3 years (13.6% vs 33.6%, <em>p</em> = 0.0001) was also significantly lower in era 2 compared to era 1. Three-year survival among BTT ECMO patients in era 2 was similar to that of patients transplanted in era 2 without ECMO support (87% vs 85.7%, <em>p</em> = 0.75). In multivariable analysis of BTT-ECMO patients in era 2, every 1 kg/m<sup>2</sup> increase in body mass index was associated with higher mortality at 3 years (hazard ratio (HR) 1.09, 95% CI 1.02-1.15, <em>p</em> = 0.006). Similarly, both post-HT stroke (HR 5.58, 95% CI 2.57-12.14, <em>p</em> < 0.001) and post-HT renal failure requiring hemodialysis (HR 4.36, 95% CI 2.43-7.82, <em>p</em> &","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912958","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":"Added prognostic value of visually estimated coronary artery calcium among heart transplant recipients","authors":"Kevin J. Clerkin MD, MSc ,&nbsp;Lorenzo Sewanan MD, PhD ,&nbsp;Jan M. Griffin MD ,&nbsp;Ersilia M. DeFilippis MD ,&nbsp;Boyu Peng MS ,&nbsp;Margarita Chernovolenko MD ,&nbsp;Erin Harris MD ,&nbsp;Nikil Prasad MD ,&nbsp;Paolo C. Colombo MD ,&nbsp;Melana Yuzefpolskaya MD ,&nbsp;Justin Fried MD ,&nbsp;Jayant Raikhelkar MD ,&nbsp;Veli K. Topkara MD, MSc ,&nbsp;Michelle Castillo BS ,&nbsp;Elaine Y. Lam PA-C ,&nbsp;Farhana Latif MD ,&nbsp;Koji Takeda MD, PhD ,&nbsp;Nir Uriel MD, MSc ,&nbsp;Gabriel Sayer MD ,&nbsp;Andrew J. Einstein MD, PhD","doi":"10.1016/j.healun.2024.07.024","DOIUrl":"10.1016/j.healun.2024.07.024","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac hybrid positron emission tomography/computed tomography (PET/CT) has become a valid screening modality for cardiac allograft vasculopathy (CAV) following heart transplantation (HT). Visually estimated coronary artery calcium (VECAC) can be quantified from CT images obtained as part of PET/CT and has been shown to be associated with adverse cardiovascular outcomes in coronary artery disease. We investigated the prognostic value of VECAC following HT.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 430 consecutive adult HT patients who underwent ¹³N-ammonia cardiac PET/CT from 2016 to 2019 with follow-up through October 15, 2022, was performed. VECAC categories included: VECAC 0, VECAC 1–9, VECAC 10–99, and VECAC 100+. The association between VECAC categories and outcomes was assessed using univariable and multivariable proportional hazards regression. The primary outcome was death/retransplantation.</div></div><div><h3>Results</h3><div>The cohort was 73% male, 33% had diabetes, 67% had estimated glomerular filtration rate &lt;60 ml/min, median age was 61 years, and median time since HT was 7.5 years. VECAC alone was insufficiently sensitive to screen for CAV. During a median follow-up of 4.2 years ninety patients experienced death or retransplantation. Compared with those with VECAC 0, patients VECAC 10–99 (HR 2.25, 95% CI 1.23–4.14, <em>p</em> = 0.009) and VECAC 100+ (HR 3.42, 95% CI 1.96–5.99, <em>p</em> &lt; 0.001) experienced an increased risk of death/retransplantation. The association was similar for cardiovascular death and cardiovascular hospitalization. After adjusting for other predictors of death/retransplantation, VECAC 10–99 (VECAC 10–99: aHR 1.95, 95% CI 1.03–3.71 <em>p</em> = 0.04) and VECAC 100+ (VECAC 100+: aHR 2.33, 95% CI 1.17–4.63, <em>p</em> = 0.02) remained independently associated with death/retransplantation.</div></div><div><h3>Conclusions</h3><div>VECAC is an independent prognostic marker of death/retransplantation following HT and merits inclusion as a part of post-HT surveillance PET/CT.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912957","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":"Extended survival of 9- and 10-gene-edited pig heart xenografts with ischemia minimization and CD154 costimulation blockade-based immunosuppression.","authors":"Ryan Chaban, Ikechukwu Ileka, Gannon McGrath, Kohei Kinoshita, Zahra Habibabady, Madelyn Ma, Victoria Diaz, Akihiro Maenaka, Anthony Calhoun, Megan Dufault, Ivy Rosales, Christiana M Laguerre, Seyed-Amir Sanatkar, Lars Burdorf, David L Ayares, William Eyestone, Prachi Sardana, Kasinath Kuravi, Lori Sorrells, Seth Lederman, Caroline G Lucas, Randall S Prather, Kevin D Wells, Kristin M Whitworth, David K C Cooper, Richard N Pierson","doi":"10.1016/j.healun.2024.07.022","DOIUrl":"10.1016/j.healun.2024.07.022","url":null,"abstract":"<p><strong>Background: </strong>Xenotransplantation has made significant advances recently using pigs genetically engineered to remove carbohydrate antigens, either alone or with addition of various human complement, coagulation, and anti-inflammatory ''transgenes''. Here we evaluated results associated with gene-edited (GE) pig hearts transplanted in baboons using an established costimulation-based immunosuppressive regimen and a cold-perfused graft preservation technique.</p><p><strong>Methods: </strong>Eight baboons received heterotopic abdominal heart transplants from 3-GE (GalKO.β4GalNT2KO.hCD55, n = 3), 9-GE (GalKO.β4GalNT2KO.GHRKO.hCD46.hCD55. TBM.EPCR.hCD47. HO-1, n = 3) or 10-G (9-GE+CMAHKO, n = 2) pigs using Steen's cold continuous perfusion for ischemia minimization. Immunosuppression (IS) included induction with anti-thymocyte globulin and αCD20, ongoing αCD154, MMF, and tapered corticosteroid.</p><p><strong>Results: </strong>All three 3-GE grafts functioned well initially, but failed within 5 days. One 9-GE graft was lost intraoperatively due to a technical issue and another was lost at POD 13 due to antibody mediated rejection (AMR) in a baboon with a strongly positive pre-operative cross-match. One 10-GE heart failed at POD113 with combined cellular and antibody mediated rejection. One 9-GE and one 10-GE hearts had preserved graft function with normal myocardium on protocol biopsies, but exhibited slowly progressive graft hypertrophy until elective necropsy at POD393 and 243 respectively. Elevated levels of IL-6, MCP-1, C-reactive protein, and human thrombomodulin were variably associated with conditioning, the transplant procedure, and clinically significant postoperative events.</p><p><strong>Conclusion: </strong>Relative to reference genetics without thrombo-regulatory and anti-inflammatory gene expression, 9- or 10-GE pig hearts exhibit promising performance in the context of a clinically applicable regimen including ischemia minimization and αCD154-based IS, justifying further evaluation in an orthotopic model.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889463","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":"Local intragraft humoral immune responses in chronic lung allograft dysfunction.","authors":"Ei Miyamoto, Daniel Vosoughi, Jinguo Wang, Jamal Al-Refaee, Gregory Berra, Tina Daigneault, Allen Duong, Betty Joe, Sajad Moshkelgosha, Shaf Keshavjee, Kathryn Tinckam, David Hwang, Andrzej Chruscinski, Stephen Juvet, Tereza Martinu","doi":"10.1016/j.healun.2024.07.019","DOIUrl":"10.1016/j.healun.2024.07.019","url":null,"abstract":"<p><strong>Background: </strong>Donor human leukocyte antigen (HLA)-specific antibodies (DSA) and non-HLA antibodies can cause allograft injury, possibly leading to chronic lung allograft dysfunction (CLAD) after lung transplantation. It remains unclear whether these antibodies are produced locally in the graft or derived solely from circulation. We hypothesized that DSA and non-HLA antibodies are produced in CLAD lungs.</p><p><strong>Methods: </strong>Lung tissue was prospectively collected from 15 CLAD patients undergoing retransplantation or autopsy. 0.3 g of fresh lung tissue was cultured for 4 days without or with lipopolysaccharide or CD40L: lung culture supernatant (LCS) was sampled. Protein eluate was obtained from 0.3 g of frozen lung tissue. The mean fluorescence intensity (MFI) of DSA and non-HLA antibodies was measured by Luminex and antigen microarray, respectively.</p><p><strong>Results: </strong>LCS from all 4 patients who had serum DSA at lung isolation were positive for DSA, with higher levels measured after CD40L stimulation (CD40L⁺LCS). Of these, only 2 had detectable DSA in lung eluate. MFI of non-HLA antibodies from CD40L⁺LCS correlated with those from lung eluate but not with those from sera. Flow cytometry showed higher frequencies of activated lung B cells in patients whose CD40L⁺LCS was positive for DSA (n = 4) or high non-HLA antibodies (n = 6) compared to those with low local antibodies (n = 5). Immunofluorescence staining showed CLAD lung lymphoid aggregates with local antibodies contained larger numbers of IgG⁺ plasma cells and greater IL-21 expression.</p><p><strong>Conclusions: </strong>We show that DSA and non-HLA antibodies can be produced within activated B cell-rich lung allografts.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889464","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":"A remembrance of Daniel R. Goldstein, MD","authors":"Joseph G. Rogers MD","doi":"10.1016/j.healun.2024.07.008","DOIUrl":"10.1016/j.healun.2024.07.008","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901995","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":"Recipient outcomes with extended criteria donors using advanced heart preservation: Response letter and insights into the data","authors":"R. Moayedifar,&nbsp;A. Zuckermann","doi":"10.1016/j.healun.2024.07.023","DOIUrl":"10.1016/j.healun.2024.07.023","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901994","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":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(24)01763-7","DOIUrl":"10.1016/S1053-2498(24)01763-7","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961223","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":"Just a number? Donor age and (lack of) associated reasons for heart offer refusal","authors":"Aprotim C. Bhowmik BS, EdM ,&nbsp;Brian Wayda MD, MPH ,&nbsp;Helen Luikart RN ,&nbsp;Yingjie Weng MHS ,&nbsp;Shiqi Zhang MS ,&nbsp;R. Patrick Wood MD ,&nbsp;Javier Nieto MD ,&nbsp;Tahnee Groat MPH ,&nbsp;Nikole Neidlinger MD ,&nbsp;Jonathan Zaroff MD ,&nbsp;Darren Malinoski MD ,&nbsp;Kiran K. Khush MD, MAS","doi":"10.1016/j.healun.2024.07.020","DOIUrl":"10.1016/j.healun.2024.07.020","url":null,"abstract":"<div><div>The use of 50+ year-old donors for heart transplant (HT) is rare in the United States. We assessed reasons for this—and whether it reflects concern about age itself or associated risk factors—using a survey of US HT centers. The Donor Heart Study enrolled US adult potential heart donors from 2015 to 2020. A total of 6,814 surveys across 2,197 donors cited, on average, 2.4 reasons (per donor) for offer refusal. Age was cited often (by ≥50% of centers surveyed) for 715 donors (33%). In this subgroup, accompanying donor-related reasons for refusal were infrequent, with no cardiac abnormality cited in most cases. Donor age showed associations with (1) age as a reason for refusal and (2) discard. Both abruptly increased at age 50: 55% of 50 to 51-year-old donors were refused often due to age (vs 38% of 48-49-year-olds), and 72% were discarded (vs 55% of 48-49-year-olds), despite no evidence of a threshold effect of age on outcomes.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875033","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":"Ten-year follow-up cohort of the everolimus versus azathioprine multinational prospective study focusing on intravascular ultrasound findings","authors":"In-Cheol Kim MD, PhD ,&nbsp;Randall C. Starling MD, MPH ,&nbsp;Kiran Khush MD ,&nbsp;Elizabeth Passano ,&nbsp;James Mirocha MS ,&nbsp;Peter Bernhardt ,&nbsp;Babak Azarbal MD ,&nbsp;Richard Cheng ,&nbsp;Fardad Esmailian MD ,&nbsp;Donna Mancini ,&nbsp;Jignesh K. Patel MD, PhD ,&nbsp;Takuma Sato MD ,&nbsp;Shaida Varnous MD ,&nbsp;Jon A. Kobashigawa MD","doi":"10.1016/j.healun.2024.07.021","DOIUrl":"10.1016/j.healun.2024.07.021","url":null,"abstract":"<div><h3>Background</h3><div>Long-term clinical outcomes of early intravascular ultrasound (IVUS) findings in a prospective cohort of heart transplantation (HTx) patients have not been evaluated.</div></div><div><h3>Methods</h3><div>This study included patients from 20 centers across Europe and North and South America among the original cohort of the RAD B253 study. Among these patients, 91 had paired IVUS images at baseline and 1-year post-transplant: everolimus 1.5 mg group (<em>n</em> = 25), everolimus 1.5 mg group (<em>n</em> = 33), and azathioprine 3.0 group (<em>n</em> = 33). The primary outcome was a composite of cardiovascular death, retransplantation, myocardial infarction (MI), coronary revascularization, and cardiac allograft vasculopathy (CAV) within a 10-year follow-up period. The secondary outcome was all-cause death, cardiovascular death, retransplantation, MI, coronary revascularization, and CAV. Donor disease was defined as baseline maximal intimal thickness (MIT) &gt;0.66 mm, and rapid progression was defined as a change in MIT &gt; 0.59 mm at 1 year.</div></div><div><h3>Results</h3><div>Donor disease (46 patients) was associated with a higher incidence of the primary outcome (hazard ratio (HR) 4.444, 95% confidence interval [CI] 1.946-10.146, <em>p</em> &lt; 0.001). Rapid progression (44 patients) was associated with a significantly higher incidence of the primary outcome (HR 2.942, 95% CI 1.383-6.260, <em>p</em> = 0.005). Higher-risk features on IVUS (positive both donor disease and rapid progression) were independently associated with poor clinical outcomes (HR 4.800, 95% CI 1.816-12.684, <em>p</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>An increase in baseline MIT and a change in first-year MIT in IVUS post HTx was associated with poor outcomes up to 10 years. Early IVUS findings can be considered as surrogate endpoints for evaluating long-term outcomes in HTx clinical trials.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875035","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":"Retinal microvascular remodeling associates with adverse events in continuous-flow left ventricular assist device-supported patients.","authors":"Sambavan Jeyakumar, Helen Nguyen, Desiree Robson, Nick Olsen, Bruno Schnegg, Peter Macdonald, Clare L Fraser, Gerald Liew, Jacky Jiang, Christopher Hayward, Kavitha Muthiah","doi":"10.1016/j.healun.2024.07.017","DOIUrl":"10.1016/j.healun.2024.07.017","url":null,"abstract":"<p><strong>Background: </strong>Continuous-flow left ventricular assist device (cfLVAD) use is effective in supporting patients with end-stage heart failure (ESHF). Reduced flow pulsatility within the systemic circulation in cfLVAD-supported patients may lead to alterations within the microcirculation. Temporal changes in microvasculature in relation to adverse events in cfLVAD-supported patients have not been studied. We aimed to profile changes within retinal microvasculature and its association with adverse events.</p><p><strong>Methods: </strong>Retinal photography was performed using Topcon TRC-NW8 nonmydriatic fundus camera in cfLVAD-supported patients and ESHF control patients. Specific retinal measurements were evaluated using a validated semiautomated program. Demographic and adverse event data were documented.</p><p><strong>Results: </strong>Forty-eight patients were studied (n = 29 cfLVAD, n = 19 ESHF). There were significant trends in retinal arteriolar caliber (B = -0.53 µm, 95% confidence interval [CI]: -0.96 to -0.10, p = 0.016) and retinal fractal dimension parameters (B = 0.014, 95% CI: 0.001-0.002, p = 0.016) in linear mixed model regressions. Among cfLVAD patients, there was a significant association between the incidence of gastrointestinal bleeding and stepwise increases in retinal arteriolar-venular caliber ratio (hazard ratio: 3.03, 95% CI: 2.06-4.45, p = 0.005), a measure of arteriolar narrowing.</p><p><strong>Conclusions: </strong>We have observed for the first time that alterations in retinal microvasculature in cfLVAD-supported patients may be associated with gastrointestinal bleeding. While understanding these temporal changes may predict future adverse events in cfLVAD-supported patients, further multicenter studies are required to confirm the associations observed.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875034","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}