The Journal of Heart and Lung Transplantation最新文献

{"title":"Bridging Therapy and Residual Pulmonary Hypertension After Pulmonary Endarterectomy: Unmet Needs in Evidence and Clinical Decision-Making.","authors":"Gianluca Pagnoni,Aurora Vicenzi,Francesca Coppi","doi":"10.1016/j.healun.2026.04.015","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.015","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702254","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":"Likelihood of Lung Transplantation Before and After Introduction of the Lung Composite Allocation Score.","authors":"Tatenda G Mupfudze,Samantha Weiss,Chelsea J Hawkins,Rebecca R Goff,Matthew Hartwig,Maryam Valapour","doi":"10.1016/j.healun.2026.04.011","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.011","url":null,"abstract":"BACKGROUNDContinuous distribution (CD), implemented in March 2023, marked the most substantial revision to United States (U.S.) lung allocation since the lung allocation score (LAS) was introduced in 2005. We evaluated whether inequities observed under LAS changed after CD.METHODSWe conducted a retrospective study of 5,887 adult candidates listed for lung transplant in the U.S. during the pre-CD (March 8, 2021-March 8, 2022) and post-CD (March 9, 2023-March 8, 2024) eras using Organ Procurement and Transplantation Network data. Multivariable competing risk models identified factors associated with the 1-year cumulative incidence of lung transplant.RESULTSPre-CD, blood type O (sHR, 0.83; 95%CI, 0.76-0.91), female birth sex (sHR, 0.69; 95%CI, 0.61-0.78), and listing in the Northeast (sHR, 0.75; 95%CI, 0.67-0.85) were associated with lower likelihood of transplant. Post-CD, younger age at listing (per 5-year decrease; sHR, 1.03; 95%CI, 1.01-1.06) and listing in the West (sHR, 1.17; 95%CI, 1.05-1.30) were associated with higher likelihood of transplant. Additionally, post-CD, diagnosis group B (sHR, 0.69; 95%CI, 0.55-0.87) and D (sHR, 0.86; 95%CI, 0.78-0.94), blood type O (sHR, 0.66; 95%CI, 0.60-0.72), and shorter stature (per 5 cm decrement; sHR, 0.91; 95%CI, 0.88-0.94) were associated with lower likelihood of transplant.CONCLUSIONCD altered factors associated with lung transplantation in the U.S. Younger age was associated with higher likelihood of transplant, and sex-based disparities diminished under the CAS. However, disadvantages for blood type O and short stature persist under CAS. Ongoing policy refinement is needed to promote equity and optimize outcomes.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702167","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":"Utility of donor-derived cell-free DNA testing after lung transplantation in the precision medicine era.","authors":"Brian C Keller,Sean Agbor-Enoh,Michael B Keller,Sravanthi Nandavaram,Adriana Zeevi,John F McDyer,Steven R Hays,S Samuel Weigt,John A Belperio,David M Sayah,Shambhu Aryal,Jonathan B Orens,Anil J Trindade,Ciara M Shaver,Jonathan C Yeung,Shaf Keshavjee,Tereza Martinu,Maria M Crespo,Jason D Christie,Joshua M Diamond,Selim M Arcasoy,Rade Tomic,Pablo G Sanchez,Derek E Byers,Scott M Palmer,Kieran Halloran,Alice L Gray,Daniel F Dilling,Jake G Natalini,Cynthia J Gries,Marie M Budev,Nirmal S Sharma,David J Ross,Sangeeta Bhorade,Gerald J Berry,Kiran K Khush,Robert N Woodward,Jennifer N Gray,Christopher R Ensor,Deborah J Levine","doi":"10.1016/j.healun.2026.04.005","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.005","url":null,"abstract":"Donor-derived cell-free DNA (dd-cfDNA) is a validated, highly sensitive, plasma molecular biomarker of allograft injury after solid organ transplantation. Robust experiences with dd-cfDNA testing after kidney and heart transplantation have generated interest in this biomarker within the lung transplantation (LTx) community. A growing body of evidence now provides increased insight into dd-cfDNA utility for molecular monitoring of lung allograft health after transplantation. The expanding understanding of lung allograft injury to appropriately frame the advancing role of dd-cfDNA in the evolution of the diagnostic approach after LTx is described. Performance characteristics of both laboratory-based shotgun-sequenced testing from the Genome Transplant Dynamics (GTD) and Genomic Research Alliance for Transplantation (GRAfT) consortia, as well as commercially available central lab-based algorithmic next-generation sequenced dd-cfDNA tests for lung transplant recipients (LTR) (AlloSure, CareDx and Prospera, Natera) are described. Kinetics of dd-cfDNA in LTRs over time, in multiple different clinical scenarios, from several investigator groups are aggregated. Phenotypes of lung allograft injury, such as acute lung allograft dysfunction, and associated dd-cfDNA patterns and performance are identified in alignment with established definitions and evolving molecular injury insights. Certain patterns of molecular injury that may predict long-term outcomes including chronic lung allograft dysfunction and mortality are examined. Lastly, clinical approaches to testing and interpretation of dd-cfDNA results in LTRs, a practical approach to using dd-cfDNA, and a rational framework for interpreting dd-cfDNA results in LTRs are presented.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147695168","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":"Rethinking Paracorporeal Lung Assist Device Support in the Modern Era: Why so different than ECMO?","authors":"Daniel Cooper,Darren Turner,David S Cooper,Don Hayes,David L S Morales","doi":"10.1016/j.healun.2026.04.014","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.014","url":null,"abstract":"BACKGROUNDPediatric patients with combined irreversible pulmonary disease and right ventricular (RV) failure on conventional ECMO face significant challenges with rehabilitation and transplant candidacy. We describe our institutional experience with a novel paracorporeal lung assist device (PLAD) configuration as a bridge to lung transplantation.METHODSThree pediatric patients with refractory pulmonary hypertension and RV failure were supported with PLAD utilizing an inline pump, left atrial appendage cannulation via a ringed Gore-Tex conduit, and main pulmonary artery cannulation.RESULTSAll three patients demonstrated substantial clinical improvement on PLAD support. Pulmonary artery pressures decreased significantly, RV function improved, and patients achieved successful physical and nutritional rehabilitation, including independent ambulation. All patients successfully underwent bilateral lung transplantation, with one patient avoiding heart-lung transplantation. Two patients are currently >1 year post-transplant with excellent outcomes.CONCLUSIONSPLAD with inline pump support represents an effective bridge to lung transplantation in pediatric patients with combined pulmonary and RV failure. This configuration enables comprehensive cardiac and physical rehabilitation while reducing pulmonary artery pressures, potentially expanding transplant candidacy and improving outcomes.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147684808","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":"Timing is everything: Using time-varying binary indicators for evaluating post-transplant risk factors.","authors":"Megan L Neely,Dmitry Tumin,Lianne K Siegel","doi":"10.1016/j.healun.2026.04.012","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.012","url":null,"abstract":"Risk factors often emerge after transplantation, yet many analyses treat them as fixed at the time of transplant, producing inaccurate or counterintuitive results due to immortal time bias. Using infection‑related hospitalizations after heart transplantation as an example, we show how incorporating a time‑varying binary indicator (TVBI) in a Cox model for such hospitalizations properly aligns the timing of the exposure with survival follow‑up and yields more credible effect estimates. We summarize key assumptions, diagnostic checks, and limitations of the TVBI approach, and highlight complementary visualization tools. Together, these methods offer a clear framework for estimating the impact of post‑transplant exposures on survival after heart and lung transplantation.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666589","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":"The Final Common Pathway: Why Etiology May Not Be Destiny in Cardiogenic Shock.","authors":"Vanessa Blumer,Diana De Oliveira-Gomes","doi":"10.1016/j.healun.2026.04.010","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.010","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666590","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":"Mesenchymal Stromal Cells for Chronic Lung Allograft Dysfunction: Biological Promise, Conflicting Signals, and the Case for Further Investigation.","authors":"Jesper M Magnusson","doi":"10.1016/j.healun.2026.04.013","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.013","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655674","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":"Long-Term Outcomes of Stent-Based Pulmonary Angioplasty for Isolated Peripheral Pulmonary Artery Stenosis.","authors":"Misaki Kanezawa,Hiroto Shimokawahara,Kentaro Ejiri,Daiki Kishigami,Keiichiro Kuronuma,Shinsuke Yuasa,Hiromi Matsubara","doi":"10.1016/j.healun.2026.04.003","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.003","url":null,"abstract":"BACKGROUNDIsolated peripheral pulmonary artery stenosis (PPAS) is a rare condition without standardized therapeutic strategies. Short-term clinical benefits of stent implantation have been reported; however, long-term durability and the incidence and determinants of in-stent restenosis (ISR) remain unclear.METHODSThis single-center retrospective study included 23 consecutive adults with isolated PPAS who underwent stent-based angioplasty between 2007 and 2024. Changes in hemodynamics, six-minute walk distance, and long-term survival were assessed. Predictors of ISR were evaluated using Cox proportional hazards models with a patient-level frailty term to account for within-patient clustering.RESULTSAmong 23 patients, 479 stents were implanted. Mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance, and six-minute walk distance significantly improved following stent-based angioplasty. The 3-year cumulative incidence of ISR was 45.8%. Smaller stent diameter (hazard ratio [HR]: 0.582, 95% confidence interval [CI]: 0.381-0.889, P = 0.012), longer stent length (HR: 1.027, 95% CI: 1.005-1.049, P = 0.017), and higher mPAP at stenting (HR: 1.017, 95% CI: 1.000-1.034, P = 0.045) were independently associated with ISR. Among lesions requiring reintervention, the 3-year cumulative incidence of recurrent ISR was 52.0%. Despite frequent ISR, most lesions were successfully retreated, with sustained improvements in hemodynamics and functional capacity. Estimated 5- and 10-year survival rates were 90.4% and 80.4%, respectively.CONCLUSIONSIn isolated PPAS, ISR appears to be common and potentially manageable through structured surveillance and timely reintervention. This strategy is associated with preserved favorable clinical outcomes and long-term survival, potentially serving as a bridge to, or a means of deferring, lung transplantation.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"77 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663817","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":"Considerations on residual pulmonary hypertension after pulmonary endarterectomy - a multimodal approach.","authors":"Paula Appenzeller,Hakim Ghani,Joanna Pepke-Zaba","doi":"10.1016/j.healun.2026.04.004","DOIUrl":"https://doi.org/10.1016/j.healun.2026.04.004","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663819","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 the STEMI Paradigm: Expanding the Scope of microAxial Flow Pump in Cardiogenic Shock.","authors":"Aurore Ughetto,Benedikt Schrage,Monika Fürholz,Antoine Beurton,Wiktor Kuliczkowski,Laurent Bonello,Guillaume Leurent,Ana Hurtado,Philippe Gaudard,Frederic Bouisset,Jonas Sundermeyer,Lukas Hunziker,Julien Imbault,Agnieszka Tycinska,Arthur Chouaikhi-Perrois,Marta Zaleska Kociecka,Angela Dettling,Hadrien Pichené,Leo Lemarchand,Vasileios Panoulas,Matias Jacomet,Mikolaj Blaziak,Aneta Klotzka,Miloud Cherbi,Clément Delmas, ","doi":"10.1016/j.healun.2026.03.036","DOIUrl":"https://doi.org/10.1016/j.healun.2026.03.036","url":null,"abstract":"BACKGROUNDMicroaxial flow pumps (mAFP) are increasingly used to treat cardiogenic shock (CS), but most evidence comes from acute myocardial infarction-related CS (AMI-CS). It remains unclear whether patients with non-ischemic CS (Non-AMI-CS) derive comparable benefits from mAFP support. This study aimed to compare clinical profiles, management strategies, and outcomes between AMI-CS and Non-AMI-CS patients treated with mAFP.METHODSWe retrospectively analyzed CS patients managed with mAFP (Impella CP and 5 + [5.0 and 5.5]) across 11 high-volume centers between 2010 and 2023. Propensity score matching was performed to account for baseline differences. The primary outcome was all-cause mortality at 180 days. Independent predictors of mortality were identified using multivariable logistic regression analysis.RESULTSA total of 976 patients were included (64.0% AMI-CS; 36.0% Non-AMI-CS). From 2010 to 2023, 180-day mortality significantly declined in both groups (Ptrend = 0.01 for AMI-CS and 0.03 for Non-AMI-CS). After propensity score matching (n = 444), 180-day mortality was comparable between AMI-CS and Non-AMI-CS patients (32.9% vs 33.3%; HR 0.89 [95% CI, 0.65-1.21]; p = 0.46). Rates of heart transplantation (5.0% vs 9.0%; p = 0.08) and durable LVAD implantation (10.8% vs 9.0%; p = 0.77) were also similar. These findings were consistent across all prespecified subgroups and at 10-year follow-up. Independent predictors of mortality in both groups included age (per 5-year increase), SCAI stage E, lactate ≥6 mmol/L), norepinephrine use, and renal replacement therapy. Despite similar survival, Non-AMI-CS patients demonstrated greater myocardial recovery, with larger LVEF improvement (+17.8 ± 17.0% vs +11.2 ± 14.5%; p < 0.001).CONCLUSIONSIn this large, real-world cohort, ischemic and non-ischemic CS showed equivalent long-term outcomes under mAFP support. These findings suggest that patient selection should be guided by shock severity and hemodynamic phenotype rather than etiology alone, supporting broader evaluation of mAFP use.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"27 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655677","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}