Journal of Heart and Lung Transplantation最新文献

{"title":"Comment on: Derivation and validation of a noninvasive prediction tool to identify pulmonary hypertension in patients with IPF: Evolution of the model FORD","authors":"David A. Zisman MD, MS","doi":"10.1016/j.healun.2024.08.009","DOIUrl":"10.1016/j.healun.2024.08.009","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 12","pages":"Page 2044"},"PeriodicalIF":6.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644235","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":"Aortic insufficiency in the patient on contemporary durable left ventricular assist device support: Comment","authors":"Hinpetch Daungsupawong , Viroj Wiwanitkit","doi":"10.1016/j.healun.2024.08.007","DOIUrl":"10.1016/j.healun.2024.08.007","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 12","pages":"Pages 2048-2049"},"PeriodicalIF":6.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644232","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":"Response to: Derivation and validation of a noninvasive prediction tool to identify pulmonary hypertension in patients with IPF: Evolution of the model FORD","authors":"Steven D. Nathan MD , Ho Cheol Kim MD , Abhimanyu Chandel MD","doi":"10.1016/j.healun.2024.08.023","DOIUrl":"10.1016/j.healun.2024.08.023","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 12","pages":"Page 2045"},"PeriodicalIF":6.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644237","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":"Xenotransplantation of mitochondria: A novel strategy to alleviate ischemia-reperfusion injury during ex vivo lung perfusion.","authors":"Nicholas B Bechet, Aybuke Celik, Margareta Mittendorfer, Qi Wang, Tibor Huzevka, Gunilla Kjellberg, Embla Boden, Gabriel Hirdman, Leif Pierre, Anna Niroomand, Franziska Olm, James D McCully, Sandra Lindstedt","doi":"10.1016/j.healun.2024.10.033","DOIUrl":"10.1016/j.healun.2024.10.033","url":null,"abstract":"<p><strong>Background: </strong>Ischemia-reperfusion injury (IRI) plays a crucial role in the development of primary graft dysfunction (PGD) following lung transplantation. A promising novel approach to optimize donor organs before transplantation and reduce the incidence of PGD is mitochondrial transplantation.</p><p><strong>Methods: </strong>In this study, we explored the delivery of isolated mitochondria in 4 hours ex vivo lung perfusion (EVLP) before transplantation as a means to mitigate IRI. To provide a fresh and viable source of mitochondria, as well as to streamline the workflow without the need for donor muscle biopsies, we investigated the impact of autologous, allogeneic, and xenogeneic mitochondrial transplantation. In the xenogeneic settings, isolated mitochondria from mouse liver were utilized while autologous and allogeneic sources came from pig skeletal muscle biopsies.</p><p><strong>Results: </strong>Treatment with mitochondrial transplantation increased the P/F ratio and reduced pulmonary peak pressure of the lungs during EVLP, compared to lungs without any mitochondrial transplantation, indicating IRI mitigation. Extensive investigations using advanced light and scanning electron microscopy did not reveal evidence of acute rejection in any of the groups, indicating safe xenotransplantation of mitochondria.</p><p><strong>Conclusions: </strong>Future work is needed to further explore this novel therapy for combating IRI in lung transplantation, where xenotransplantation of mitochondria may serve as a fresh, viable source to reduce IRI.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622074","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":"Factors associated with waitlist clinical deterioration among United States lung transplant recipients under the continuous distribution system.","authors":"Tatenda G Mupfudze, Chelsea J Hawkins, Samantha Weiss, Rebecca R Goff, Grace R Lyden, Erika D Lease, Matthew Hartwig, Maryam Valapour","doi":"10.1016/j.healun.2024.10.032","DOIUrl":"10.1016/j.healun.2024.10.032","url":null,"abstract":"<p><strong>Background: </strong>Lung continuous distribution (CD), implemented on March 9, 2023, changed the calculation and relative importance of medical urgency and post-transplant survival in prioritizing candidates for transplant. We aimed to identify factors associated with waitlist clinical deterioration and change in expected post-transplant survival from listing to transplant in the current system.</p><p><strong>Methods: </strong>We used Organ Procurement and Transplantation Network (OPTN) data to conduct a retrospective study of 2,395 adult, lung-only transplant recipients added to the waiting list and transplanted between March 9, 2023 and March 8, 2024. We used multivariable linear regression to identify factors associated with change in waitlist area under the curve and post-transplant area under the curve, representing expected survival (in days) without and with transplant, respectively.</p><p><strong>Results: </strong>In multivariable analysis, longer waiting time (β = -1.3 per 7 days; p < 0.001), male birth sex (β = -11; p = 0.006), diagnosis group D (β = -27; p < 0.001), and blood type O (β = -13; p < 0.001) were associated with greater clinical deterioration from listing to transplant. Older (β = 3.2 per 10-year increase in age; p = 0.023) and taller (β = 3.0 per 5 cm increase in height; p = 0.003) recipients were less likely to clinically deteriorate from listing to transplant. Diagnosis group D (β = -4.7, p = 0.032) and blood type O (β = -4.2, p = 0.025) recipients had lower expected post-transplant survival at transplant compared to listing.</p><p><strong>Conclusions: </strong>Our findings suggest the need to further investigate and address factors associated with waitlist clinical deterioration under CD. Future analysis of the effect of waitlist clinical deterioration on post-transplant outcomes under CD is needed.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622051","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 donor age ≥65 years on graft survival in large lung transplant cohorts.","authors":"Andrei M Darie, Bronwyn J Levvey, Helen V Shingles, Miranda A Paraskeva, Kovi Levin, Samantha L Ennis, Michael Perch, Glen P Westall, Gregory I Snell","doi":"10.1016/j.healun.2024.11.002","DOIUrl":"10.1016/j.healun.2024.11.002","url":null,"abstract":"<p><strong>Background: </strong>Although the demand for allografts continuously surpasses the supply, the majority of lungs offered for transplant are declined based on various factors, including donor age. This in turn sustains the wait-list mortality of patients with end-stage pulmonary disease.</p><p><strong>Methods: </strong>In this single-center, observational cohort study, we investigated the impact of donor age on graft survival. We additionally compared our center's data to data reported to the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant Registry. Kaplan-Meier method was used to describe overall graft survival. Multivariate Cox proportional hazards regression was used to assess clinical features associated with graft loss.</p><p><strong>Results: </strong>Between January 2010 and December 2023, Alfred performed 1,101 single and double lung transplants and the combined ISHLT cohort totaled 32,200 transplants. At Alfred, grafts originating from donors ≥65 years were used in 13.3% of lung transplant cases and univariate analysis showed no impact of donor age ≥65 on graft survival (hazard ratio [HR] 0.86, p = 0.34). In the combined cohort, North America had a lower proportion of donors aged ≥65 years compared to Europe and the Alfred (2.4% vs 9.8% vs 13.3%, p < 0.001). The univariate analysis showed a negative impact of donor age ≥65 on graft survival (HR 1.16, p < 0.001). However, this did not hold in a multivariate model (HR 1.06, p = 0.298) when adjusted for center experience and recipient characteristics.</p><p><strong>Conclusions: </strong>Donor age might impact outcomes to a lesser degree than previously suggested. Therefore, appropriately assessed age-extended lungs should be routinely considered for lung transplantation.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622054","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":"Risk assessment models and survival in pulmonary arterial hypertension: a SPAHR analysis.","authors":"Clara Hjalmarsson, Tanvee Thakur, Tracey Weiss, Erik Björklund, Joanna-Maria Papageorgiou, Göran Rådegran, Stefan Söderberg, Håkan Wåhlander, Dominik Lautsch, Barbro Kjellström","doi":"10.1016/j.healun.2024.10.029","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.029","url":null,"abstract":"<p><strong>Background: </strong>Multicomponent improvement (MCI) is a novel endpoint for predicting survival in patients with pulmonary arterial hypertension (PAH), included in the sotatercept clinical program. For the first time, we investigated the prognostic value of MCI, ESC/ERS 4-strata risk (4SR) assessment, and the non-invasive French risk stratification score (FRS), for predicting survival in PAH patients in Sweden. All risk prediction models are based on three parameters: WHO-FC (World Health Organization Functional Class), NT-proBNP, and 6MWD (6-minute walk distance).</p><p><strong>Methods: </strong>Data from the Swedish PAH & CTEPH Registry (SPAHR) collected 2008-2021 were used for the analyses. The association of MCI achievement, 4SR, and FRS calculated at 6 months (6M), with transplant-free (TF) survival was investigated in the whole cohort, as well as categorized by age (<65 and ≥65 years). All risk prediction models are based on three parameters: WHO-FC (World Health Organization Function Class), NT-proBNP, and 6MWD (6-minute walk distance). Kaplan-Meier estimate/Log-Rank test and Cox proportional model were used for survival analyses.</p><p><strong>Results: </strong>The study included 411 patients (70% women) with a median [IQR] age of 66y.²¹ At 6M, the mean (SD) NT-proBNP decrease was 808 (603) and the mean 6MWD increase was 44 (11) meters. Median survival/follow-up time was 3.5y [1.7, 5.4]. After adjustment for sex and comorbidities, achievement of MCI independently predicted TF-survival; one MCI-criterion met (HR 0.65; CI 0.46-0.92, p=0.015); two MCI-criteria met (HR 0.45; CI 0.31-0.66, p<0.001); all three MCI-criteria met (HR 0.32; CI 0.21-0.52, p<0.001). Likewise, 4SR and FRS demonstrated a strong association with TF-survival with patients achieving lower risk scores exhibiting longer survival compared to those with higher risk scores. Patients ≥65Y more often had connective tissue disease-associated PAH, lower DLCO, more pronounced comorbidity burden, higher risk at baseline, less improvement during follow-up, and worse TF-survival then patients <65Y.</p><p><strong>Conclusion: </strong>All models were found to have prognostic relevance for TF-survival. Risk prediction was incremental with the number of low-risk criteria met, while improvements in only one of 6MWD, NT-proBNP, or FC showed a modest association with survival. The risk assessment tools predicted outcome in patients across both age categories.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622067","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":"Toward early prediction of chronic allograft dysfunction using molecular biomarkers.","authors":"Peter T Bell, Daniel C Chambers","doi":"10.1016/j.healun.2024.11.001","DOIUrl":"10.1016/j.healun.2024.11.001","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622071","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":"Optimized surveillance frequency for low bone mineral density (BMD) screening using dual-energy X-ray absorptiometry (DXA) in patients after lung transplant.","authors":"Ronnie Sebro, Mahmoud Elmahdy","doi":"10.1016/j.healun.2024.10.028","DOIUrl":"10.1016/j.healun.2024.10.028","url":null,"abstract":"<p><strong>Background: </strong>Approximately 2,700 lung transplants are performed annually in the United States. These patients are at increased risk of developing low bone mineral density (BMD) (osteopenia/osteoporosis) and subsequent fractures. Dual-energy X-ray absorptiometry (DXA) is the most common method used for screening for low BMD; however, the optimal surveillance frequency for low BMD using DXA is unknown.</p><p><strong>Methods: </strong>We evaluated the change in femoral neck, total femur, L1, L2, L3, and L4 BMD after lung transplant in a retrospective cohort of 259 patients (69.9% male) who were followed with serial DXA scans for a median of 725 (interquartile range [361-1,116]) days after transplant. Generalized linear mixed-effects models adjusting for sex, time, time-squared, baseline osteopenia/osteoporosis, active rejection, and their interaction terms were used to model the rate of change of BMD at each site. The final multivariable models for the femoral neck, L1, and L4 BMD measurements had random slopes and intercepts, and the models for the total hip, L2, and L3 measurements had random slopes.</p><p><strong>Results: </strong>Sixty-five percent of the patients undergoing lung transplants had osteopenia or osteoporosis before transplant. Men exhibited higher baseline BMD levels compared to women at all sites (p < 0.001 for all). After the transplant, the greatest rate of BMD decrease was at the femoral neck. Although patients with low BMD had significantly lower baseline BMDs (p < 0.001 for all), they experienced a slower rate of BMD decrease at all sites compared to patients with normal BMD at baseline (p < 0.001 for all). All patients received corticosteroids. Patients with low BMD at baseline had significantly higher odds of receiving bisphosphonate therapy (odds ratio = 3.95, 95% confidence interval [CI] [1.44, 13.51], p = 0.003). We estimated that a significant change in the femoral neck BMD would be expected to occur within 409 days (95% CI [131, 708]) and again at 867 days (95% CI [551, 1,216]) after lung transplant.</p><p><strong>Conclusions: </strong>Patients undergoing lung transplant should be screened annually with DXA for the first 2 years after transplant, consistent with the current International Society for Heart and Lung Transplantation guidelines.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622058","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 systematic review of reporting and handling of missing data in observational studies using the UNOS database.","authors":"William L Baker, Timothy E Moore, Eric Baron, Michelle Kittleson, William F Parker, Abhishek Jaiswal","doi":"10.1016/j.healun.2024.10.023","DOIUrl":"10.1016/j.healun.2024.10.023","url":null,"abstract":"<p><strong>Background: </strong>Missing data decreasing study power and introducing bias, thereby undermining a registry's ability to draw valid inferences. We evaluated how missing data are reported and addressed in heart transplantation (HT) studies using the United Network for Organ Sharing (UNOS) database.</p><p><strong>Methods: </strong>We conducted a systematic literature search of Medline from January 1, 2018 through August 22, 2023 and included studies that used the UNOS database to evaluate adult (≥18 years) de novo HT recipients. We collected details on the study population, timeframe, primary end-point, use of missing data, and whether and what methods were used to handle missing data. Approaches were classified as variable selection, complete case analysis (CCA), missing indicator method, single imputation, or multiple imputation.</p><p><strong>Results: </strong>Of the 229 included studies, 67 (29.3%) limited their cohorts to those without missing data for the outcome or key variables and 93 (40.6%) reported missing data in their final cohort. 78 (34.1%) studies reported how they handled missing data in their statistical modeling. Of these, CCA was most used (n = 41, 52.6%) followed by multiple imputation (n = 22, 28.2%), and other methods (n = 15, 19.2%). Thirty-one (13.5%) studies reported removing covariates from their analysis because of missingness.</p><p><strong>Conclusions: </strong>Merely a third of the identified UNOS database studies reported how they handled missing data in their analysis, with strategies varying. Although no singular approach to handling missing data exists, methods are available that can improve upon the most used approaches. Future best practices should include explicit reporting of missingness, detailed methods, and sensitivity checks.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622048","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}