JHLT Open最新文献

英文中文

Trends in primary graft dysfunction and early mortality following lung transplantation: A single center experience 肺移植后原发性移植物功能障碍和早期死亡率的趋势：单中心经验

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-15 DOI: 10.1016/j.jhlto.2026.100488

Yuriko Terada , Michael K. Pasque , Chad A. Witt , Ruben G. Nava , Benjamin D. Kozower , G. Alexander Patterson , Daniel Kreisel , Varun Puri , Ramsey R. Hachem , Tsuyoshi Takahashi

Objectives

Although the long-term prognosis after lung transplantation has improved recently, primary graft dysfunction (PGD) remains the major cause of early mortality. The aim of this study was to elucidate trends in PGD incidence and short-term mortality following lung transplantation in the contemporary era.

Methods

We analyzed a single-center database of lung transplantations performed across three periods (Era 1: 2009–2013, Era 2: 2014–2017, and Era 3: 2018–2021). PGD was graded according to the 2016 International Society for Heart and Lung Transplantation definition, and PGD grade 3 within T0–T72 was used as the primary outcome. Trends in PGD incidence, factors associated with PGD, and early mortality rates after lung transplantation were identified.

Results

This study included 856 lung transplants: 277 in Era 1, 296 in Era 2, and 283 in Era 3. PGD grade 3 incidence decreased significantly over time: 35.9% (99 cases) in Era 1, 26.4% (78 cases) in Era 2, and 18.4% (52 cases) in Era 3 (P<0.001). During the study period, the lung allocation score (LAS) and intraoperative cardiopulmonary bypass (CPB) use decreased, whereas the use of intraoperative nitric oxide and extracorporeal membrane oxygenation increased. Logistic multivariate modeling identified era, recipient sex (male), underlying disease, race, and blood transfusion as factors associated with PGD. No significant difference was observed in 30-day hospital mortality across the three eras (2.9%, 1.4%, and 1.4% for Era 1, Era 2, and Era 3, respectively; P=0.313).

Conclusion

This study demonstrated a significant reduction in PGD incidence over time, which coincided with a decrease in LAS and intraoperative CPB use. However, no significant changes were observed in short-term mortality after lung transplantation.

目的虽然肺移植术后的长期预后近年来有所改善，但原发性移植物功能障碍（PGD）仍然是早期死亡的主要原因。本研究的目的是阐明当代肺移植术后PGD发病率和短期死亡率的趋势。方法：我们分析了三个时期（第1时代：2009-2013年，第2时代：2014-2017年和第3时代：2018-2021年）进行肺移植的单中心数据库。PGD按照2016年国际心肺移植学会（International Society for Heart and Lung Transplantation）的定义进行分级，以T0-T72内的PGD 3级作为主要终点。确定了肺移植后PGD发病率的趋势、与PGD相关的因素和早期死亡率。结果本研究共纳入856例肺移植：1277例，296例，283例。PGD 3级的发病率随着时间的推移显著下降：第1时代为35.9%（99例），第2时代为26.4%（78例），第3时代为18.4%（52例）（P<0.001）。在研究期间，肺分配评分（LAS）和术中体外循环（CPB）的使用减少，而术中一氧化氮和体外膜氧合的使用增加。Logistic多变量模型确定了年龄、受体性别（男性）、潜在疾病、种族和输血是与PGD相关的因素。三个时代的30天住院死亡率无显著差异（第1、2和3时代分别为2.9%、1.4%和1.4%；P=0.313）。结论：该研究表明PGD的发生率随着时间的推移而显著降低，这与LAS和术中CPB使用的减少相一致。然而，肺移植术后短期死亡率未见明显变化。

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引用次数: 0

Rescuing lung transplant candidates with rapidly progressive interstitial lung disease who fail V-V ECMO: A case series of dual veno-arterial and veno-venous extracorporeal membrane oxygenation circuits 抢救V-V ECMO失败的快速进展间质性肺疾病肺移植候选人：双静脉-动脉和静脉-静脉体外膜氧合回路的病例系列

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-26 DOI: 10.1016/j.jhlto.2026.100495

Enock Adjei MD , Blaine Sklar DNP, AGACNP-BC , John W. Stokes MD , Whitney D. Gannon MSN, MS , Amir Teimouri Dereshgi MD , Anil J. Trindade MD , Caitlin T. Demarest MD, PhD , Matthew Bacchetta MD, MBA , Konrad Hoetzenecker MD, PhD

Background

Providing adequate, awake and ambulatory mechanical circulatory support to patients with rapidly progressive advanced intersitial lung disease (ILD) remains challenging. In a subset of ILD patients with refractory hypoxemia or hemodynamic instability, despite optimal veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support, the addition of a veno-arterial (V-A) ECMO circuit may avoid the need for mechanical ventilation and protect against right ventricular dysfunction and subsequent end-organ dysfunction.

Methods

We herein report the first case series of three patients with ILD who received dual VV-VA ECMO support as a bridge to transplantation.

Results

All patients survived until lung transplantation 2 to 8 days after V-A ECMO initiation and had an unremarkable post-transplant recovery.

Conclusion

Although the addition a second ECMO circuit is a complex and resource-intensive strategy, it is a feasible approach to stabilze a subset of ILD patients who are indequately supported with V-V ECMO.

背景：为快速进展的晚期间质性肺疾病（ILD）患者提供足够的、清醒的、动态的机械循环支持仍然具有挑战性。在顽固性低氧血症或血流动力学不稳定的ILD患者亚群中，尽管有最佳的静脉-静脉（V-V）体外膜氧合（ECMO）支持，但增加静脉-动脉（V-A） ECMO回路可以避免机械通气的需要，并防止右室功能障碍和随后的终末器官功能障碍。方法我们在此报告首个病例系列，3例ILD患者接受双VV-VA ECMO支持作为移植的桥梁。结果所有患者在V-A ECMO启动后2 ~ 8天存活至肺移植，移植后恢复无明显差异。结论：虽然增加第二个ECMO回路是一个复杂且资源密集的策略，但它是一种可行的方法，可以稳定一部分V-V ECMO支持不足的ILD患者。

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引用次数: 0

Heart transplantation graft survival following donation after circulatory death via thoracoabdominal normothermic regional perfusion 经胸腹恒温区域灌注心脏移植供体在循环性死亡后的存活

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2025-12-17 DOI: 10.1016/j.jhlto.2025.100470

Sarah Y. Park MD , Rocio Lopez MS, MPH , Michael J. Kirsch MD, MSCR , Elizabeth J. Bashian MD , Emily Hay-Arthur BA , Jack Zakrzewski MD , Jesse D. Schold PhD , Nicholas R. Teman MD , Jordan R.H. Hoffman MD, MPH , Michael T. Cain MD

Background

The impact of thoracoabdominal normothermic regional perfusion (TA-NRP) use in donation after circulatory death (DCD) on rates of graft survival after heart transplantation has yet to be established.

Methods

A cohort study of the Scientific Registry of Transplant Recipients was performed identifying all primary adult heart transplants performed in the United States between January 1, 2020, and May 31, 2024, comparing donation after brain death (DBD), DCD with direct procurement and perfusion (DPP) (defined as declaration of circulatory death to cross clamp <30 min), and DCD with TA-NRP (defined as declaration of circulatory death to cross clamp >40 min). The primary outcome was graft loss (re-transplant or death).

Results

There were 474 (3.5%) DCD TA-NRP, 899 (6.6%) DCD DPP, and 12,185 (89.9%) DBD heart transplants during the study period, with varying donor and baseline characteristics, including more male and non-Hispanic White DCD TA-NRP recipients, and fewer DCD TA-NRP recipients listed as Status 1. On multivariable analysis, graft survival rates did not significantly differ between cohorts [Adjusted Hazard Ratio (aHR) (95% CI): 0.98 (0.70, 1.37) for DCD TA-NRP vs. DBD; and 1.04 (0.69, 1.56) for DCD TA-NRP vs. DCD DPP].

Conclusion

DCD TA-NRP recovery in heart transplantation yields comparable rates of two-year graft survival compared to DCD DPP and DBD recovery, supporting greater utilization of TA-NRP recovery in DCD allografts.

背景胸腹常温区域灌注（TA-NRP）用于循环死亡（DCD）后捐献对心脏移植后移植物存活率的影响尚未确定。方法在移植受者科学登记系统中进行队列研究，确定2020年1月1日至2024年5月31日期间在美国进行的所有原发性成人心脏移植，比较脑死亡后捐赠（DBD）、DCD与直接获取和灌注（DPP）（定义为宣布循环死亡至交叉夹30分钟）和DCD与TA-NRP（定义为宣布循环死亡至交叉夹40分钟）。主要结局为移植物丧失（再移植或死亡）。结果在研究期间，有474例（3.5%）DCD TA-NRP， 899例（6.6%）DCD DPP和12185例（89.9%）DBD心脏移植，具有不同的供体和基线特征，包括更多的男性和非西班牙裔白人DCD TA-NRP受者，以及更少的DCD TA-NRP受者被列为状态1。在多变量分析中，各组间移植物存活率无显著差异[校正风险比（aHR）（95% CI）： DCD TA-NRP vs DBD 0.98 (0.70, 1.37)；DCD TA-NRP和DCD DPP分别为1.04（0.69,1.56）。结论与DCD DPP和DBD恢复相比，心脏移植中DCD TA-NRP恢复的两年存活率相当，支持TA-NRP恢复在DCD同种异体移植中的更大应用。

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引用次数: 0

Recent change in bridging strategy and improved clinical outcomes following durable left ventricular assist device implantation in Japan 日本持久左心室辅助装置植入后桥接策略的最新变化和改善的临床结果

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-28 DOI: 10.1016/j.jhlto.2026.100499

Makiko Nakamura , Teruhiko Imamura , Yoshikatsu Saiki , Minoru Ono , Koichiro Kinugawa , on behalf of J-MACS Investigators

Background

Destination therapy (DT) was approved in Japan in May 2021. Use of Impella device as a bridge to left ventricular assist device (LVAD) implantation has been increasing. The difference of clinical outcomes between Impella-bridge (a conversion from Impella to durable left ventricular assist device [LVAD]), bridge-to-bridge (BTB) (a conversion from extracorporeal LVAD to durable LVAD), and primary LVAD remains unclear especially in Japanese.

Methods

Patients who underwent durable LVAD implantation between October 2017 and March 2025 and were prospectively registered in the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS) were included. The baseline characteristics, cumulative mortality, and adverse events following durable LVAD implantation were retrospectively compared between 2 bridging strategies and primary LVAD cohort.

Results

A total of 964 patients who received durable LVAD implantation (median age: 49 years; primary LVAD: 77.4%; Impella-bridge: 11.6%; BTB: 11.0%) were analyzed. The prevalence of Impella-bridge strategy increased especially after DT approval and the introduction of Impella 5.5. The cumulative mortality during durable LVAD support was lowest in Impella-bridge cohort and highest in BTB cohort during a median follow-up of 1053 days (8.0% vs 21.0%). Among the total cohort, an Impella-bridge strategy tended to be associated with a lower mortality following durable LVAD implantation with an adjusted hazard ratio of 0.316 (95% confidence interval 0.095-1.048, p = 0.060).

Conclusions

Impella-bridge strategy increased after the introduction of Impella 5.5 in the era of DT and tended to be associated with a lower mortality following durable LVAD implantation. Further studies are warranted to validate the hypothesis.

目的疗法（DT）于2021年5月在日本获得批准。使用Impella装置作为左心室辅助装置（LVAD）植入的桥梁已经越来越多。Impella-bridge（从Impella到耐用左室辅助装置[LVAD]的转换）、桥对桥（BTB）（从体外左室辅助装置到耐用左室辅助装置的转换）和原发性左室辅助装置的临床结果差异尚不清楚，特别是在日本。方法纳入2017年10月至2025年3月期间在日本机械辅助循环支持注册中心（J-MACS）前瞻性注册的持久LVAD植入患者。对两种桥接策略和初始LVAD队列的基线特征、累积死亡率和不良事件进行回顾性比较。结果共分析964例接受持久LVAD植入的患者（中位年龄49岁，原发LVAD占77.4%，Impella-bridge占11.6%，BTB占11.0%）。特别是在DT批准和Impella 5.5引入之后，Impella-bridge策略的流行度增加了。在中位随访1053天期间，持续LVAD支持期间的累积死亡率在Impella-bridge队列中最低，在BTB队列中最高（8.0% vs 21.0%）。在整个队列中，Impella-bridge策略倾向于与持久LVAD植入后较低的死亡率相关，校正风险比为0.316（95%可信区间0.095-1.048,p = 0.060）。结论在DT时代引入Impella 5.5后，simpella -bridge策略增加，并与持久LVAD植入后较低的死亡率相关。需要进一步的研究来证实这一假设。

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引用次数: 0

Expedited Lung Allocation in The Era of Continuous Distribution 连续分布时代的快速肺分配

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-14 DOI: 10.1016/j.jhlto.2026.100487

Sajjad Ali , Robin High , Marian Urban , David Axelrod , Steven Potter , Aleem Siddique

Background

The frequency of use of expedited offers in lung allocation has increased.

Methods

This study retrospectively analyzed lung offers accepted for transplant in the United States for the period from the introduction of continuous distribution in allocation in March 2023 to March 2024 to identify characteristics of donors, recipients, and offers associated with expedited placement. Data were obtained from the Scientific Registry of Transplant Recipients and categorized by expedited vs non-expedited offers.

Results

Of the 3,136 lung organ offers transplanted, 9% (284) were expedited. Expedited offers were more likely for male donors with blood type O, while recipients were typically older, male, non-Hispanic, and diagnosed with lung condition category A. These recipients also demonstrated lower composite allocation and medical urgency scores, and were less likely to be hospitalized, ventilated, or on extracorporeal life support. Time on the waitlist and post-transplant 30-day survival rates were similar between expedited and non-expedited groups. One-year survival was higher in recipients of expedited lung placements. Expedited offers had a median sequence number at acceptance of 83.5, bypassing a median of 54.5 listed patients, and were more often placed at centers with higher offer acceptance ratios.

Conclusion

Expedited placements are associated with lower-acuity recipients. Further policy reform should aim to ensure equity while optimizing organ placement and recipient outcomes.

背景：在肺分配中使用加急报价的频率有所增加。方法本研究回顾性分析了美国从2023年3月至2024年3月引入连续分配分配以来接受移植的肺供体的特征，确定供体、受体和与加速安置相关的供体。数据从移植受者科学登记处获得，并按加急和非加急提供分类。结果3136例肺器官移植中，9%（284例）的肺器官移植得到了加速。O型血的男性献血者更有可能获得加急服务，而接受者通常是年龄较大的男性，非西班牙裔，并且被诊断为a类肺病。这些接受者也表现出较低的综合分配和医疗紧急评分，并且住院，通气或体外生命支持的可能性较小。等待名单上的时间和移植后30天存活率在加速组和非加速组之间相似。加速肺植入的接受者一年生存率更高。加急报价的中位数序列号为83.5，绕过了列出的患者的中位数54.5，并且更经常被放置在报价接受率较高的中心。结论快速安置与低视力受者相关。进一步的政策改革应旨在确保公平，同时优化器官安置和接受者的结果。

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引用次数: 0

First implantation of a bioprosthetic total artificial heart for a mediastinal paraganglioma 纵隔副神经节瘤首次植入生物假体全人工心脏

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-09 DOI: 10.1016/j.jhlto.2026.100485

Ali Akamkam MD, MSc , Marie-Eve Garcia MD , Elie Fadel MD, PhD , Julien Guihaire MD, PhD

Resection of cardiac-invasive tumors is challenging, as transplantation is not a viable option for patients with cancer. We report the first implantation of the Aeson total artificial heart (TAH) (Carmat, Vélizy-Villacoublay, France), as a bridge to transplant in a patient with a mediastinal paraganglioma. A 54-year-old man presented with restrictive heart failure related to a paraganglioma. The tumor was invading the right ventricle. No tumor reduction was achieved after chemotherapy. A surgical resection of the tumor combined with the implantation of the Aeson TAH was decided. Embolization of the nutrient vessels of the tumor was performed before surgery to decrease hemorrhagic risk. A positron emission tomography scan at 3 months showed no tumor recurrence. The patient was transplanted 6 months after TAH implantation. No severe primary graft dysfunction or acute rejection was observed. However, the patient developed refractory vasoplegia, which ultimately led to multiorgan failure and death 6 months after transplantation.

心脏侵袭性肿瘤的切除是具有挑战性的，因为移植对癌症患者来说不是一个可行的选择。我们报告了第一例植入Aeson全人工心脏（TAH）（Carmat， v录影带- villacoublay，法国），作为纵隔副神经节瘤患者移植的桥梁。一个54岁的男人提出限制性心力衰竭与副神经节瘤。肿瘤正在侵入右心室。化疗后未见肿瘤缩小。决定手术切除肿瘤并植入Aeson TAH。术前对肿瘤营养血管进行栓塞以降低出血风险。3个月的正电子发射断层扫描显示肿瘤未复发。患者于TAH植入术后6个月进行移植。没有观察到严重的原发性移植物功能障碍或急性排斥反应。然而，患者出现难治性血管截瘫，最终导致移植后6个月多器官衰竭死亡。

引用次数: 0

A 3-stage hybrid strategy for heart transplantation following ascending-to-descending aortic bypass grafting 升降主动脉搭桥术后心脏移植的三期混合策略。

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-12 DOI: 10.1016/j.jhlto.2026.100486

Salem T. Argaw , Ali Akamkam , Sébastien Hascoet , Stéphan Haulon , Julien Guihaire MD, PhD

Cardiac reoperation after an extra-anatomic aortic bypass graft entails considerable risk due to the proximity of the graft to the sternum. In the case discussed here, a woman with 2 prior sternotomies and a retrosternal aortic bypass graft for a history of aortic coarctation presented with advanced dilated cardiomyopathy requiring heart transplantation. The patient was managed through a novel 3-stage hybrid strategy. In the first stage, a catheter-based approach was used to stent the coarcted aorta. Subsequently, the extra-anatomic graft was endovascularly excluded and, finally, the patient underwent reoperation for heart transplantation. The use of interdisciplinary collaboration for coordinated staging and shared decision-making, as in this case, allows for innovative solutions and improved outcomes in complex surgical needs.

解剖外主动脉搭桥术后心脏再手术由于移植物靠近胸骨，有相当大的风险。在这里讨论的病例中，一名因主动脉缩窄病史而接受过两次胸骨切开术和胸骨后主动脉搭桥手术的女性，表现为晚期扩张型心肌病，需要心脏移植。患者通过一种新的三阶段混合策略进行治疗。在第一阶段，使用导管为基础的方法来支架狭窄的主动脉。随后，排除血管内解剖外移植物，最后，患者再次接受心脏移植手术。在本例中，利用跨学科合作来协调分期和共同决策，可以为复杂的手术需求提供创新的解决方案和改善的结果。

引用次数: 0

Promoting utilization of donors after circulatory death in lung transplantation 促进肺移植中循环死亡后供体的利用

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-15 DOI: 10.1016/j.jhlto.2026.100491

Doug A. Gouchoe MD , Ashley Cardenas MAS, FAST , Gary F. Marklin MD, MA , Errol Bush MD , Bryan A. Whitson MD, PhD , Jordan R.H. Hoffman MD, MPH , Darren Stewart MS , David A. Axelrod MD, MBA , Aleem Siddique MBBS, FACS, FACC

Lungs recovered from donation after circulatory death (DCD) are markedly underutilized for transplantation in the U.S. Evidence demonstrating excellent outcomes after DCD lung transplantation underpins the need for strategies to mitigate barriers to DCD lung utilization, including data driven revisions to allocation policy, revising program-specific quality metrics, removing financial barriers, and minimizing logistical disincentives. Expanded DCD transplantation is vital to reduce waitlist mortality and increase lung transplant rate.

在美国，循环死亡（DCD）后捐赠恢复的肺在移植中明显未得到充分利用，证据表明，DCD肺移植后的良好结果支持了减轻DCD肺利用障碍的策略的必要性，包括数据驱动的分配政策修订，修订特定项目的质量指标，消除财务障碍，并最大限度地减少后勤障碍。扩大DCD移植对降低候诊死亡率和提高肺移植率至关重要。

引用次数: 0

The looming threat of invasive fungal infections in heart transplant recipients: Will it be the last of us 心脏移植受者侵袭性真菌感染的威胁迫在眉睫：这将是我们最后一个人吗

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-13 DOI: 10.1016/j.jhlto.2026.100482

Adam Lowe MD , S. Travis King PharmD , Jonathan Hand MD

Patients with mechanical circulatory support (MCS) devices and those who undergo heart transplants are at risk for invasive fungal infections (IFI). Though Candida and Aspergillus spp. account for most infections, the evolving epidemiology of resistant-Candida spp. such as Candida auris, endemic mycoses, and other molds impacted by climate change, threaten MCS and transplant patients. Fungal diagnostics are overall limited, and current, widely used antifungal agents are suboptimal with significant toxicities. However, innovative diagnostic strategies coupled with novel antifungal agents for prevention and treatment of invasive fungal disease encourage optimism for MCS and transplant patients and clinicians.

使用机械循环支持装置（MCS）的患者和接受心脏移植的患者存在侵袭性真菌感染（IFI）的风险。虽然念珠菌和曲霉菌占大多数感染，但耐药念珠菌的流行病学发展，如念珠菌耳、地方性真菌病和其他受气候变化影响的霉菌，威胁着MCS和移植患者。真菌诊断总体上是有限的，目前广泛使用的抗真菌药物是次优的，具有显著的毒性。然而，创新的诊断策略加上用于预防和治疗侵袭性真菌疾病的新型抗真菌药物，使MCS和移植患者和临床医生感到乐观。

引用次数: 0

MicroRNAs and their role in heart transplantation insights into rejection mechanisms: A narrative review MicroRNAs及其在心脏移植排斥机制中的作用：综述

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-20 DOI: 10.1016/j.jhlto.2026.100496

Rossella Loria , Antonio Giuseppe Bianculli , Paola Giustiniani , Maria Troiano , Marco Andreani , Giorgia Grutter

Heart transplantation is the definitive treatment for patients with advanced heart failure and refractory symptoms. However, allograft rejection—both acute and chronic—remains a major cause of morbidity, leading to graft dysfunction and failure. Traditionally, endomyocardial biopsy (EMB) has been the standard method for screening allograft rejection. MicroRNAs (miRNAs) are small, non-coding RNA sequences that regulate gene expression by binding to the 3' untranslated regions of complementary mRNA transcripts. This review explores the potential of miRNAs as biomarkers for detecting allograft rejection in heart transplant recipients. MiRNAs may serve as non-invasive “liquid biopsies,” providing a novel approach to monitor and manage post-transplant patients.

心脏移植是晚期心力衰竭和难治性症状患者的最终治疗方法。然而，同种异体移植物的急性和慢性排斥反应仍然是导致移植物功能障碍和衰竭的主要原因。传统上，心内膜心肌活检（EMB）一直是筛选同种异体移植排斥反应的标准方法。MicroRNAs （miRNAs）是一种小的非编码RNA序列，通过结合互补mRNA转录物的3'非翻译区来调节基因表达。这篇综述探讨了mirna作为检测心脏移植受者同种异体移植排斥反应的生物标志物的潜力。mirna可以作为非侵入性的“液体活检”，提供一种监测和管理移植后患者的新方法。

引用次数: 0

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