The Journal of Heart and Lung Transplantation最新文献

{"title":"Predicting Expiration Among Potential Donation after Circulatory Death Donors at 30- and 120 Minutes Post Extubation.","authors":"John P White,Joseph Song,Peter D Cho,Hedwig Zappacosta,Stephanie McKay,Alexey Abramov,Malini Daniel,Tom Seto,Sharon West,Donatello Telesca,Majid Husain,Angshuman Saha,Abbas Ardehali","doi":"10.1016/j.healun.2026.04.006","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.006","url":null,"abstract":"PURPOSEMany potential Donation After Circulatory Death (DCD) donors do not progress to circulatory death within meaningful timeframes, leading to wasted procurement resources. We therefore sought to develop robust machine learning models to predict donor expiration at 30- and 120-minutes following extubation.METHODSWe performed a retrospective cohort study using data from three organ procurement organizations, analyzing 4,464 potential DCD donors from 2014-2025 across 61 clinical variables. Primary endpoints were binary expiration at 30- and 120- minutes post-extubation. Three cohorts were constructed. Regression analysis utilized the \"complete-case dataset\", while \"max sample\" (n=4,464; 14 variables) and \"max variable\" (n=2,092; 61 variables) datasets were used for XGBoost modeling to maintain completeness >85%. Results were evaluated using receiver operating characteristic (ROC) and precision-recall (PR) area under the curve (AUC).RESULTSRegression modeling yielded modest results. Among the machine learning models, the max variable model had the highest performance and yielded ROC-AUCs of 76% and 89% for 30- and 120-minutes, respectively, while PR-AUCs reached 80% and 97%. In both the 30- and 120- minute models final cough, lung offer, arterial blood gas pH, and serum platelets were among the top 6 variables of importance.CONCLUSIONThese models represent the most sophisticated approach to predicting DCD donor expiration to date. By leveraging a large multicenter cohort and nonlinear machine-learning techniques, our model more accurately captures the complex physiologic dynamics governing donor progression. While further validation is warranted, this framework has potential to reduce futile procurements and more accurately allocate resources, expanding access to life-saving transplantation.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147743862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Primary Graft Dysfunction: Rethinking Cardiogenic Shock After Heart Transplantation.","authors":"Kristjan Karason","doi":"10.1016/j.healun.2026.04.021","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.021","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147743854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FILONEX - A Prospective, Randomized Controlled Pilot Safety Study Evaluating the Addition of Hemodiafiltration to EVLP in Marginal Donor Lungs.","authors":"Panja M Boehm,Sophia Auner,Oya Berezhinskiy,Jakob Homola,Thomas Schweiger,Stefan Schwarz,Johannes Geilen,Shahrooz Nasrollahi-Shirazi,Gabriella Murakoezy,Peter Jaksch,Konrad Hoetzenecker,Clemens Aigner,Alberto Benazzo","doi":"10.1016/j.healun.2026.04.009","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.009","url":null,"abstract":"BACKGROUNDThe lack of physiologic clearance mechanisms during ex vivo lung perfusion (EVLP) may lead to electrolyte imbalances, accumulation of toxic metabolites and disturbances in starling forces. The integration of dialysis may help to maintain perfusate physiology. The FILONEX trial investigates the feasibility and safety of this strategy.METHODSThis single-center prospective randomized controlled study included 30 marginal donor lungs randomized 1:1 at procurement. Normothermic acellular EVLP was performed for six hours. After one hour, hemodiafiltration (HDF) was added to the EVLP circuit in the treatment group, whereas the control group received EVLP without any adjunct therapy. Primary endpoints were suitability for transplantation after EVLP, and primary graft dysfunction (PGD) grade 3 at 72 hours after transplantation.RESULTSDonor and recipient characteristics were similar between the groups. Electrolyte levels, lactate and pH remained within physiological ranges only in the treatment group. Acceptance rate was 47% (n=7) in the control and 80% (n=12) in the treatment group. PGD grade 3 at ICU admission was 57% (n=4) in the control and 25% (n=3) in the treatment group (p=0.093). There were no cases of PGD grade 3 at 72 hours in either group. In 3 (43%) control patients, VA-ECMO was prolonged postoperatively compared to 1 (8%) patient in the treatment group (p=0.075). Length of mechanical ventilation, ICU stay, hospital stay and short-term mortality were comparable among the groups.CONCLUSIONThis prospective randomized trial demonstrates that integrating HDF into the EVLP circuit is feasible and safe during six hours of perfusion, without adverse effects on EVLP performance or short-term outcomes after lung transplantation.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early United States experience with donation after circulatory death for heart retransplantation.","authors":"Alexander R Berg,Aravind Krishnan,Elbert E Heng,Alice Zhou,Andreas Maskos,Daniel I Alnasir,Jeffrey Teuteberg,Y Joseph Woo,John W MacArthur","doi":"10.1016/j.healun.2026.02.1673","DOIUrl":"https://doi.org/10.1016/j.healun.2026.02.1673","url":null,"abstract":"BACKGROUNDDonation after circulatory death (DCD) expands the heart donor pool, but outcomes after adult heart retransplantation (re-TX) are not well defined.METHODSUsing UNOS STAR data (January 1, 2019 to October 1, 2025), we studied adults undergoing orthotopic re-TX. Exposure was donor mechanism (DCD vs donation after brain death [DBD]). The primary outcome was 365-day mortality assessed with Kaplan-Meier methods and multivariable Cox regression. We also performed 2:1 propensity-score matching (PSM) using prespecified covariates.RESULTSAmong 474 re-TX recipients, 53 (11.2%) received DCD hearts; DCD use rose to 32% of re-TX in 2025 (partial year). Compared with DBD, DCD recipients had lower transplant acuity (ECMO 1.9% vs 18.3%; mechanical ventilation 0.0% vs 10.0%) and differed in allocation status (p<0.001), with more Adult Status 4 listings (56.6% vs 26.6%). Perioperative complications and early mortality were similar by donor type. Unadjusted survival did not differ at 90 days (log-rank p=0.51) or 365 days (p=0.42). In adjusted Cox regression, donor mechanism was associated with 365-day mortality (DCD vs DBD hazard ratio 2.27, 95% CI 1.02-5.02; p=0.044). In the matched cohort (DCD n=51; DBD n=96), survival differed by donor mechanism at 90 days (p=0.03) and 365 days (p=0.009).CONCLUSIONSDCD re-TX use is increasing and is concentrated in lower-acuity recipients. While perioperative outcomes were similar, risk-adjusted and matched analyses identified differences in 1-year survival by donor mechanism, supporting cautious, selection-sensitive implementation and continued evaluation as experience and follow-up accrue.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor - Early post lung transplant neutrophil dynamics within 72 hours.","authors":"Berber Zweers,Sue Braithwaite,Linda de Heer,Leo Koenderman,Nienke Vrisekoop,Bart Luijk","doi":"10.1016/j.healun.2026.04.018","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.018","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Transplantation in the GLP-1 Era: Time to Catch Up?. Invited Commentary for \"The association between glucagon-like peptide 1 receptor agonist therapy and outcomes after heart transplant\".","authors":"Nitish K Dhingra,Subodh Verma","doi":"10.1016/j.healun.2026.04.017","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.017","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"423 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiogenic Shock in Heart Transplant Recipients: A Multicenter Cohort Study with Matched Analysis.","authors":"Chahem Harba,Alexis David-Papadopoulos,Anouk Frering,Guillaume Lebreton,Soulef Guendouz,Shaida Varnous,Juliette Chommeloux,Marc Pineton de Chambrun,Guillaume Hékimian,Charles-Edouard Luyt,Julien Guihaire,Romain Sonneville,Alain Combes,Matthieu Schmidt,Quentin Moyon, ","doi":"10.1016/j.healun.2026.03.035","DOIUrl":"https://doi.org/10.1016/j.healun.2026.03.035","url":null,"abstract":"BACKGROUNDThis study aimed to evaluate the prognosis of heart transplant recipients (HTR) with graft failure-related cardiogenic shock (CS), identify predictors of one-year event-free survival, and compare their outcomes to those of patients with other CS etiologies.METHODSThis retrospective multicenter study included all HTR admitted to the ICU between June 2006 and August 2024 for CS occurring ≥ 1 month after transplantation. The primary endpoint was one-year survival, without retransplantation, or long-term circulatory support. HTR receiving VA-ECMO were compared with propensity score matching to two external ECMO control cohorts: (1) patients with CS due to acute myocardial infarction (AMICS); and (2) immunocompromised patients with CS from various causes.RESULTSAmong the 145 HTR included, the primary causes of shock were cardiac allograft rejection (51%), coronary allograft vasculopathy (19%), and other causes (30%), with no significant differences in survival across etiologies. Event-free survival was 25% at one year. Independent predictors of one-year event-free survival included CAV grade ≥2 (HR 2.4; 95% CI, 1.6-3.7), renal replacement therapy at ICU admission (HR 1.9; 95% CI, 1.2-3.1), SCAI stage of cardiogenic shock ≥ D (HR 3.6; 95% CI 2.1 to 6.3), and ECMO initiated on cardiopulmonary resuscitation (HR 2.5; 95% CI, 1.5-4.1). In a matched analysis of VA-ECMO patients, heart transplant recipients had significantly lower 90-day survival than matched AMICS patients (22% vs 55%), whereas survival was not significantly different when compared with other immunocompromised non-transplant patients (28% vs 42%).CONCLUSIONCS occurring after heart transplantation is associated with very poor outcomes, with only one quarter of patients free from death, retransplantation, or durable mechanical circulatory support at one year. While prognosis appeared worse than in matched patients with AMICS requiring VA-ECMO, outcomes did not significantly differ from those of other immunocompromised patients receiving the same support.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the Individualized Probability of Myocardial Recovery: The Multicenter RecoverHeart Calculator.","authors":"Iosif Taleb,Christos P Kyriakopoulos,Omar Wever-Pinzon,Eleni Maneta,Craig H Selzman,Elizabeth Dranow,Eleni Tseliou,Ioannis Kyriakoulis,Maya Guglin,Scott C Silvestry,Jennifer A Cowger,Josef Stehlik,James C Fang,Thomas C Hanff,Konstantinos Sideris,Marisca Nelson,Daniel Tang,Ahmad A Abdul-Aziz,Lauren Parker,Andrija Vidic,Stephen McKellar,Michael J Bonios,Christos Kapelios,Antigone Koliopoulou,Gerasimos Fillipatos,Emma J Birks,Mark S Slaughter,Carmelo Milano,Ravi Karra,Manreet K Kanwar,Palak Shah,Stavros G Drakos","doi":"10.1016/j.healun.2026.04.008","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.008","url":null,"abstract":"BACKGROUNDRecent reports from UNOS and INTERMACS highlight that left ventricular assist devices (LVADs) remain underutilized as a bridge-to-recovery (BTR) strategy, despite data from registries and other studies demonstrating that a meaningful subset of patients experience substantial improvements in cardiac structure and function during LVAD support. A reliable tool to estimate the likelihood of cardiac recovery could aid clinicians and heart failure (HF) patients in making informed decisions when considering advanced therapies such as LVAD implantation and heart transplantation.OBJECTIVESTo develop and externally validate a practical calculator estimating an individual patient's likelihood of cardiac recovery during LVAD support.METHODSThe derivation cohort included chronic HF patients supported with continuous-flow LVADs from 5 institutions. An external validation cohort comprised patients from 4 additional institutions. The primary model endpoint was \"significant reverse remodeling\", defined as achieving LVEF ≥40% and LV end-diastolic diameter ≤6 cm within one year of LVAD implantation. A multivariable prediction model estimating individualized probability of this outcome was developed and externally validated as the RecoverHeart calculator.RESULTSThe derivation cohort included 509 patients and the validation cohort comprised 375 patients. Significant reverse remodeling was observed in 76 patients (14.9%) in the derivation cohort and 42 patients (11.2%) in the validation cohort. Key preimplant predictors included female sex, shorter HF duration, non-ischemic cardiomyopathy, and smaller left ventricular end-diastolic diameter. The RecoverHeart calculator demonstrated good discrimination, with a C statistic of 0.72 (95% CI: 0.66-0.79) in the derivation cohort and 0.75 (95% CI: 0.67-0.76) in the validation cohort. The model stratified patients across a wide range of predicted probabilities for significant reverse remodeling (0.2%-67.6%) and outperformed previously published models and individual predictors.CONCLUSIONSThe RecoverHeart Calculator is a practical and validated tool that estimates individualized probability of significant reverse remodeling in LVAD patients. By informing patient selection and counseling, it may facilitate shared decision making, help address the underutilization of LVADs as BTR therapy and maximize the therapeutic benefits of both LVAD and heart transplantation.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making the Most of Time with Advanced Heart Failure: A Patient's Journey.","authors":"Salina R Rivera","doi":"10.1016/j.healun.2026.04.016","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.016","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"311 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147708520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of DCD Heart Transplantation in Europe and the United States: A multi-centre, retrospective study.","authors":"John O Louca,Marco Öchsner,Ashish Shah,Kelly Schlendorf,Brian Lima,Chen Chia Wang,Hasan Siddiqi,Ali Irshad,Jacob Schroder,Sarah Casalinova,Carmelo Milano,Kiran K Khush,Anette Skoda,Helen Luikart,Euan Ashley,Nader Moazami,Les James,Owais Dar,Mailen Konicoff,Marian Urban,John Um,Anthony Castleberry,Jordan R H Hoffman,Michael T Cain,Katharina Fetten,Dan Meyer,Addison Xu,Francisco González-Vilchez,Beatriz Domínguez-Gil,Mario Royo-Villanova,Iris Garrido,Sergio J Cánovas,Janne Brouckaert,Katrien Vandendriessche,Filip Rega,Vincent Tchana-Sato,Marius Berman,James Bae,Nicole Asemota,Sanjay Sinha,Stephen Pettit,Simon Messer,Stephen Large,Sai Bhagra, ","doi":"10.1016/j.healun.2026.04.007","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.007","url":null,"abstract":"BACKGROUNDDonation after the circulatory determination of death (DCD) heart transplantation (HT) is becoming more widely adopted across the United States (US) and Europe.OBJECTIVEThis study compared donor and recipient demographics, intraoperative parameters and outcomes between DCD HT centres in Europe and the US that contributed to the Outcomes after DCD Cardiac Transplantation Database.METHODSThis was a retrospective observational study across 22 HT centres in Belgium, Spain, United Kingdom (UK) and US. All patients undergoing DCD HT at participating centres, from the start of each centre's DCD program through 01/01/2023 were included with censor date 01/01/2024. The primary outcome was 1-year survival. Secondary outcomes included severe primary graft dysfunction and incidence of acute cellular rejection.RESULTSData from 223 patients in Europe and 281 in the US were analysed. DCD donors in Europe were significantly older (37years vs 28 years;p<0.001). Recipients in Europe had inferior 1-year survival (86.6% vs 91.8%;p=0.043), but 1-month and 3-years survival were similar. 1-year survival in the direct procurement and preservation (DPP) cohort was significantly higher in the US group (91.2% vs 82.6%;p=0.02). In the thoraco-abdominal normothermic regional perfusion (taNRP) cohort 1-year survival was similar between Europe and the US. Recipients in Europe had higher use of mechanical circulatory-assist post-transplant (17.9% vs 11%;p=0.03).CONCLUSIONThis study further confirms the safety and efficacy of DCD HT across centres in the US and Europe, despite important differences in donor and recipient demographics and clinical outcomes. Continued collection of international data may identify opportunities to improve outcomes.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147708521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}