Journal of Heart and Lung Transplantation最新文献

Background: There is a paucity of data informing on the current use, adverse events, outcomes, and prognostic drivers for patients receiving venopulmonary extracorporeal life support (VP ECLS). We aimed to provide a contemporary, large sample size study to describe the real-world outcomes of adults supported with VP ECLS across different clinical conditions.

Methods: We queried the Extracorporeal Life Support Organization (ELSO) Registry to retrieve all adult patients who received VP ECLS as the first support modality from July 2020 to July 2024. Study population was grouped according to hospital death outcome and to the diagnosis leading to VP ECLS use. Adverse outcomes are reported according to primary diagnosis leading to VP ECLS use. A time-to-event Cox regression model was applied to identify predictors of death.

Results: A total of 838 patients [32.3% females; age 8 (46, 67) years] were included. Patients were treated for heart failure/cardiogenic shock (HF/CS) in 54.4%, for acute respiratory failure/acute respiratory distress syndrome (ARF/ARDS) in 26.6%, for post-cardiotomy shock in 6.7%, for acute coronary syndrome/ischemic heart disease in 5.3%, for valvular heart disease/complications of intracardiac devices in 4.2%, and for pulmonary embolism in 2.9%. Most common adverse events included continuous renal replacement therapy (CRRT) use or acute kidney injury (37.4%), infections (35.4%), cardiac arrhythmias (13.5%), surgical site bleeding (12.1%), gastrointestinal (GI) bleeding (6.1%). Complications were more common in non-survivors and patterns of complications differed among diagnosis groups. The Kaplan-Meier estimated 60-day mortality was 49.3 (45.3, 53.1)%. Age (HR_adj 1.15 for 5 years increase; 95%CI 1.11, 1.20; p<0.001), female sex (HR_adj 1.40; 95%CI 1.12, 1.76; p=0.003), BMI (HR_adj 1.02 for 3 kg/m² increase; 95%CI 1.01, 1.04; p<0.018), CRRT use prior VP ECLS cannulation (HR_adj 1.44; 95%CI 1.11, 1.86; p<0.006) were independent predictors of death.

Conclusions: In this large ELSO registry analysis, VP ECLS was chiefly used for HF/CS and ARF/ARDS. Hospital outcomes, complications and survival differed according to the diagnosis leading to VP ECLS use. Younger age, male sex, lower BMI, and no CRRT use prior to VP ECLS cannulation confer a lower risk of death and provide targets for future research and potential domains for clinical improvement.

Background: Heart transplantation remains limited by ischemia-reperfusion injury (IRI). Optimizing graft preservation and modulating inflammation may improve early graft quality. We compared optimized static cold storage (SCS), hypothermic machine perfusion (HMP), and normothermic machine perfusion (NMP), and evaluated colchicine pretreatment as an adjunct anti-inflammatory strategy.

Methods: Thirty-six pigs were randomized to colchicine or placebo (n=18 each) and subsequently assigned to SCS, HMP, or NMP (n=12 per group). After 4 hours of preservation, all hearts underwent 1 hour of normothermic reperfusion. Myocardial injury, lactate extraction, systemic cytokines, and histological assessments were performed. Mixed-effects models accounting for repeated measures and treatment-preservation interactions were used for all longitudinal analyses.

Results: HMP was associated with lower H-FABP levels than SCS (β -92.6; 95% CI -183 to -2.6; p=0.04), while NMP showed no difference. Troponin I release was significantly higher in NMP versus SCS (β 97.9; 95% CI 63.4-132; p<0.001). Lactate extraction was greater with HMP compared with SCS (β 10.2; 95% CI -0.2 to 20.6; p=0.05), with no difference for NMP. Preservation modality strongly influenced inflammation: IL-6 (β 3.72; p<0.001) and TNF-α (β 0.25; p=0.003) were markedly increased in NMP, whereas IL-10 was reduced in HMP versus SCS (β -0.38; p<0.001). Colchicine had no significant effect on any biomarker. Oxidative stress proteins, apoptosis markers, and histological injury scores did not differ across preservation modalities or treatment groups.

Conclusions: In this randomized large-animal model, hypothermic preservation (SCS, HMP) provides superior metabolic and inflammatory profiles compared with NMP. Colchicine did not confer additional benefit under these conditions.

Background: Baseline lung allograft dysfunction (BLAD), defined as failure to achieve ≥ 80% predicted spirometry after lung transplant, is associated with reduced survival. This study aimed to determine the prevalence and character of computed tomography (CT) abnormalities in BLAD.

Methods: In this retrospective cohort study, we analyzed adult first-time double-lung transplant recipients (12/2017-10/2021) who had 12-month CT chest and concurrent BLAD/non-BLAD status assigned. Three radiologists used a semi-quantitative ordinal score to evaluate ground glass opacities (GGO), reticulation, consolidation, pleural effusion, bronchiectasis and air-trapping. Machine learning-trained lung texture analysis provided CT radiomic data: CT-measured total lung capacity (CT_TLC), pulmonary vessel volume (PVV), GGO, reticulation, and hyperlucency. Parametric response mapping measured functional small airways disease. ROC analysis and logistic regression identified radiologic features of BLAD.

Results: BLAD patients (n=59, 46%) had longer intubation duration, longer index hospitalization post-transplant, and lower donor-to-recipient total lung capacity (TLC) ratio than non-BLAD patients (n=69, 54%). Radiologist-assessed scoring identified more pleural effusions in BLAD with no significant differences in GGO or air trapping. Computer-aided CT demonstrated more reticulation, GGO, and parenchymal density in BLAD, with no difference in functional small airways disease. CT_TLC indexed for height was lower in BLAD while PVV was higher. PVV was significantly associated with BLAD in univariable analysis (OR 2.30, 95% CI 1.38-3.83, p<0.001), and remained strong after adjusting for age, sex, and native disease (OR=2.65,95% CI 1.45-4.84, p=0.002).

Conclusions: Computer-aided CT elicited structural changes in BLAD not captured by limited-slice radiologist review. CT_TLC and PVV were the strongest radiologic predictors of BLAD, likely reflecting restrictive physiology and vascular remodelling.