Pub Date : 2025-08-21DOI: 10.1016/j.healun.2025.06.003
Claire Irving , Estela Azeka , Rachele Adorisio , Elizabeth D. Blume , Carmel Bogle , Henry Chubb , Jennifer Conway , Melissa K. Cousino , Jonathan Edelson , Katrina Ford , Paula Holinski , Jan Janousek , Ashwin Lal , Teresa Lee , Angela Lorts , Stephanie Nakano , David N. Rosenthal , Joseph Rossano , Shelley D. Miyamoto
Pediatric heart failure (HF) secondary to cardiomyopathies, acquired heart disease, and congenital heart disease is associated with significant morbidity and mortality. These guidelines represent an update from the International Society for Heart and Lung Transplantation guidelines for the management of pediatric HF that were published in 2014 and incorporate interval advancements in medical therapies and new approaches in the evaluation and management of children with HF.
{"title":"The International Society for Heart and Lung Transplantation Guidelines for the Management of Pediatric Heart Failure (Update From 2014)","authors":"Claire Irving , Estela Azeka , Rachele Adorisio , Elizabeth D. Blume , Carmel Bogle , Henry Chubb , Jennifer Conway , Melissa K. Cousino , Jonathan Edelson , Katrina Ford , Paula Holinski , Jan Janousek , Ashwin Lal , Teresa Lee , Angela Lorts , Stephanie Nakano , David N. Rosenthal , Joseph Rossano , Shelley D. Miyamoto","doi":"10.1016/j.healun.2025.06.003","DOIUrl":"10.1016/j.healun.2025.06.003","url":null,"abstract":"<div><div>Pediatric heart failure (HF) secondary to cardiomyopathies, acquired heart disease, and congenital heart disease is associated with significant morbidity and mortality. These guidelines represent an update from the International Society for Heart and Lung Transplantation guidelines for the management of pediatric HF that were published in 2014 and incorporate interval advancements in medical therapies and new approaches in the evaluation and management of children with HF.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 10","pages":"Pages e21-e71"},"PeriodicalIF":6.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956954","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}
The diagnosis of pulmonary antibody–mediated rejection (AMR) remains challenging with lack of specific defining features. This study evaluated the diagnostic and prognostic significance of intragraft anti human leukocyte antigen (HLA) donor–specific antibodies (gDSA) in pulmonary AMR.
Methods
This multicenter prospective study enrolled adult lung transplant recipients (LTR) with serum anti-HLA DSA (sDSA) >1,000 Luminex mean fluorescence intensity (MFI). Transbronchial biopsies (TBBx) were obtained for both standard histologic analysis and cryopreservation to detect anti-HLA class I and II gDSA, using Luminex single-antigen beads assay. Clinical follow-up was conducted over 24 months. An expert pathologist reviewed all TBBx using a predefined checklist. A blinded adjudication panel categorized clinical diagnoses as possible, probable, or definite AMR and non-AMR conditions. The primary objective was to assess gDSA sensitivity and specificity for AMR diagnosis. Additionally, we compared graft outcomes between gDSA+ vs gDSA− patients.
Results
Seventy-seven LTR from 5 centers were included from August 2019 to July 2022. Twenty-nine patients were classified as probable or definite clinical/subclinical AMR. Among the cohort, 13 had positive gDSA. gDSA sensitivity, specificity, and positive predictive value for AMR diagnosis were 34.4%, 93.7%, and 76.9%, respectively. gDSA diagnostic performance for AMR was better than sDSA ≥12,500 MFI (sensitivity 37.9%, specificity 85.4%, and positive predictive value 61.1%). Event-free survival analysis (10% forced expiratory volume in 1 second decline or graft loss) showed no significant differences by gDSA positivity. Limited biopsy sampling and spatial heterogeneity may have biased sensitivity and prognostic performances of the technique.
Conclusions
gDSA might offer a specific complementary support for the clinical diagnosis of AMR following lung transplantation.
{"title":"Diagnostic significance of intragraft donor–specific anti-HLA antibodies in pulmonary antibody–mediated rejection","authors":"Sandrine Hirschi MD , Guilaine Hell PharmD , Deborah Jo Levine MD , Benjamin Coiffard MD, PhD , Francois Severac MD, MSc , Clement Picard MD , Vincent Bunel MD , Jerome Le Pavec MD, PhD , Arnaud Essaydi PharmD , Martine Reynaud-Gaubert MD, PhD , Antoine Roux MD, PhD , Olivier Brugiere MD, PhD , Benjamin Renaud-Picard MD, PhD , Romain Kessler MD, PhD , Federica Pezzuto MD, PhD , Jean-Luc Taupin PharmD, PhD , Fiorella Calabrese MD","doi":"10.1016/j.healun.2025.08.007","DOIUrl":"10.1016/j.healun.2025.08.007","url":null,"abstract":"<div><h3>Background</h3><div>The diagnosis of pulmonary antibody–mediated rejection (AMR) remains challenging with lack of specific defining features. This study evaluated the diagnostic and prognostic significance of intragraft anti human leukocyte antigen (HLA) donor–specific antibodies (gDSA) in pulmonary AMR.</div></div><div><h3>Methods</h3><div>This multicenter prospective study enrolled adult lung transplant recipients (LTR) with serum anti-HLA DSA (sDSA) >1,000 Luminex mean fluorescence intensity (MFI). Transbronchial biopsies (TBBx) were obtained for both standard histologic analysis and cryopreservation to detect anti-HLA class I and II gDSA, using Luminex single-antigen beads assay. Clinical follow-up was conducted over 24 months. An expert pathologist reviewed all TBBx using a predefined checklist. A blinded adjudication panel categorized clinical diagnoses as possible, probable, or definite AMR and non-AMR conditions. The primary objective was to assess gDSA sensitivity and specificity for AMR diagnosis. Additionally, we compared graft outcomes between gDSA+ vs gDSA− patients.</div></div><div><h3>Results</h3><div>Seventy-seven LTR from 5 centers were included from August 2019 to July 2022. Twenty-nine patients were classified as probable or definite clinical/subclinical AMR. Among the cohort, 13 had positive gDSA. gDSA sensitivity, specificity, and positive predictive value for AMR diagnosis were 34.4%, 93.7%, and 76.9%, respectively. gDSA diagnostic performance for AMR was better than sDSA ≥12,500 MFI (sensitivity 37.9%, specificity 85.4%, and positive predictive value 61.1%). Event-free survival analysis (10% forced expiratory volume in 1 second decline or graft loss) showed no significant differences by gDSA positivity. Limited biopsy sampling and spatial heterogeneity may have biased sensitivity and prognostic performances of the technique.</div></div><div><h3>Conclusions</h3><div>gDSA might offer a specific complementary support for the clinical diagnosis of AMR following lung transplantation.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 37-46"},"PeriodicalIF":6.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930156","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}
Pub Date : 2025-08-21DOI: 10.1016/j.healun.2025.07.035
Michele Gallo MD, Mark S. Slaughter MD
{"title":"What is the ideal driveline design for a Left Ventricular Assist Device?","authors":"Michele Gallo MD, Mark S. Slaughter MD","doi":"10.1016/j.healun.2025.07.035","DOIUrl":"10.1016/j.healun.2025.07.035","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Pages 1985-1986"},"PeriodicalIF":6.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956950","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}
Pub Date : 2025-08-20DOI: 10.1016/j.healun.2025.08.001
Dorothee Brunet MD, MSc , Simon Dang Van MD, MSc , Martin Kloeckner MD, MSc , David Blanchard MD , Julien Guihaire MD, PhD
Heart transplantation is increasingly reliant on marginal grafts due to organ shortages. Ex situ heart perfusion (ESHP) enables viability assessment, but current methods lack functional evaluation. We aimed to investigate the relationship between echocardiographic myocardial work index (MWI) and cardiac performance during ESHP.
Eighteen pig hearts were assigned to three groups: cold storage (BH-CS), hypothermic perfusion (BH-HP), and circulatory death (DCD). Normothermic ESHP was conducted using a working-mode setup. Cardiac output differed significantly among groups (BH-CS: 1200±573 mL/min, BH-HP: 1592±193, DCD: 676±234, p=0.012) as did MWI (440±124 mmHg%, 652±157 mmHg%, 292±122 mmHg%, p<0.001). MWI strongly correlated with cardiac output (r=0.85, p<0.001).
This study demonstrates the feasibility of noninvasive echocardiographic assessment during ESHP. MWI showed a robust correlation with cardiac performance. Although current clinical perfusion systems do not support working-mode evaluation, our findings support the development of such integrated platforms. Limitations include the lack of post-transplantation data and small sample size.
{"title":"Myocardial Work Index as an Indicator of Cardiac Function in Ex Situ Heart Perfusion","authors":"Dorothee Brunet MD, MSc , Simon Dang Van MD, MSc , Martin Kloeckner MD, MSc , David Blanchard MD , Julien Guihaire MD, PhD","doi":"10.1016/j.healun.2025.08.001","DOIUrl":"10.1016/j.healun.2025.08.001","url":null,"abstract":"<div><div>Heart transplantation is increasingly reliant on marginal grafts due to organ shortages. Ex situ heart perfusion (ESHP) enables viability assessment, but current methods lack functional evaluation. We aimed to investigate the relationship between echocardiographic myocardial work index (MWI) and cardiac performance during ESHP.</div><div>Eighteen pig hearts were assigned to three groups: cold storage (BH-CS), hypothermic perfusion (BH-HP), and circulatory death (DCD). Normothermic ESHP was conducted using a working-mode setup. Cardiac output differed significantly among groups (BH-CS: 1200±573 mL/min, BH-HP: 1592±193, DCD: 676±234, p=0.012) as did MWI (440±124 mmHg%, 652±157 mmHg%, 292±122 mmHg%, p<0.001). MWI strongly correlated with cardiac output (r=0.85, p<0.001).</div><div>This study demonstrates the feasibility of noninvasive echocardiographic assessment during ESHP. MWI showed a robust correlation with cardiac performance. Although current clinical perfusion systems do not support working-mode evaluation, our findings support the development of such integrated platforms. Limitations include the lack of post-transplantation data and small sample size.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Pages 2024-2027"},"PeriodicalIF":6.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930163","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}
Pub Date : 2025-08-20DOI: 10.1016/j.healun.2025.08.003
Paolo Hollis , Richard Issitt , Sebastiano A.G. Lava , Craig Laurence , Jacob Simmonds , Matthew Fenton , Nagarajan Muthialu , Alex Robertson , Richard Crook , Lori West , Michael Burch
Background and Aims
Pediatric heart transplantation remains hampered by the limited availability of donor organs. The introduction of ABO-incompatible (ABOi) heart transplantation for infants in the early 2000s expanded the donor pool for individual candidates. Nonetheless, concerns remain about ABOi heart transplantation in children aged over 2 years, and it has not been routinely adopted. At our center we have considered candidates aged 2-9 years for ABOi donors if isohemagglutinin titers were 1:32 or less. We report the outcomes of those who received an ABOi heart transplant. Furthermore, as all transplant-listed children in this age group were tested for isohemagglutinins, the potential for ABOi transplant was investigated.
Methods
Data were retrospectively analyzed from all pediatric heart transplants undertaken at our center between 1st January 2013 and 1st June 2023. Primary outcome measures were anti-A and/or anti-B titers at listing and whether an ABOi transplant was performed. Secondary outcome measures were survival and incidence of rejection.
Results
Sixty-two children 2-9 years of age (median age 5.1 years) underwent heart transplantation during the study period. One patient was blood group AB; of the remaining 61 patients, 51 had anti-A and/or anti-B titers measured whilst listed for transplant. Of these, 44 (86%) had isohemagglutinin titers of 1:32 or less at the time of listing, and this dropped to 40 (78%) by the time of transplant. Over the study period, 14 children (age range 2.5-8.9 years, median 4.3 years) underwent ABOi transplant; all 14 patients were well at follow-up with median follow-up time of 4.9 years, range 1.7-8.9 years.
Conclusions
Our data suggests that ABOi heart transplantation is a safe and effective option for older children, at least to 9 years of age. Furthermore, we have shown that the great majority of young children have isohemagglutinin titers in the range that ABOi transplant could be considered. These findings may have a substantial impact on donor availability worldwide. Further work is needed to see if the age range can be extended further.
{"title":"ABO-incompatible heart transplants in children aged 2-9 years: A new paradigm in transplant?","authors":"Paolo Hollis , Richard Issitt , Sebastiano A.G. Lava , Craig Laurence , Jacob Simmonds , Matthew Fenton , Nagarajan Muthialu , Alex Robertson , Richard Crook , Lori West , Michael Burch","doi":"10.1016/j.healun.2025.08.003","DOIUrl":"10.1016/j.healun.2025.08.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Pediatric heart transplantation remains hampered by the limited availability of donor organs. The introduction of ABO-incompatible (ABOi) heart transplantation for infants in the early 2000s expanded the donor pool for individual candidates. Nonetheless, concerns remain about ABOi heart transplantation in children aged over 2 years, and it has not been routinely adopted. At our center we have considered candidates aged 2-9 years for ABOi donors if isohemagglutinin titers were 1:32 or less. We report the outcomes of those who received an ABOi heart transplant. Furthermore, as all transplant-listed children in this age group were tested for isohemagglutinins, the potential for ABOi transplant was investigated.</div></div><div><h3>Methods</h3><div>Data were retrospectively analyzed from all pediatric heart transplants undertaken at our center between 1st January 2013 and 1st June 2023. Primary outcome measures were anti-A and/or anti-B titers at listing and whether an ABOi transplant was performed. Secondary outcome measures were survival and incidence of rejection.</div></div><div><h3>Results</h3><div>Sixty-two children 2-9 years of age (median age 5.1 years) underwent heart transplantation during the study period. One patient was blood group AB; of the remaining 61 patients, 51 had anti-A and/or anti-B titers measured whilst listed for transplant. Of these, 44 (86%) had isohemagglutinin titers of 1:32 or less at the time of listing, and this dropped to 40 (78%) by the time of transplant. Over the study period, 14 children (age range 2.5-8.9 years, median 4.3 years) underwent ABOi transplant; all 14 patients were well at follow-up with median follow-up time of 4.9 years, range 1.7-8.9 years.</div></div><div><h3>Conclusions</h3><div>Our data suggests that ABOi heart transplantation is a safe and effective option for older children, at least to 9 years of age. Furthermore, we have shown that the great majority of young children have isohemagglutinin titers in the range that ABOi transplant could be considered<strong>.</strong> These findings may have a substantial impact on donor availability worldwide. Further work is needed to see if the age range can be extended further.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Pages 1910-1917"},"PeriodicalIF":6.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930159","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}
Pub Date : 2025-08-20DOI: 10.1016/j.healun.2025.08.011
J.N. Andarelli , J. Issard , T. Lacoste-Palasset , I. Mallak , B. Gerardin , S. Dolidon , D. Fabre , G. Dauriat , T. Genty , D. Mitilian , O. Mercier , M. Jevnikar , X. Jaïs , M. Humbert , P. Brenot , E. Fadel
Background
Treatments for chronic thromboembolic pulmonary hypertension (CTEPH) include PH-specific pharmacotherapy (PHSP), balloon pulmonary angioplasty (BPA), and pulmonary endarterectomy (PEA). We evaluated a sequential multimodal strategy (SMS) combining PHSP, BPA, and PEA in selected high-surgical-risk patients with distal lesions in one lung and proximal lesions in the other.
Methods
In this prospective observational study, patients were selected to the SMS by a multidisciplinary panel, based on hemodynamic severity, location of lesions, and comorbidity profile. Characteristics and complications of procedures were collected. Clinical, laboratory, and hemodynamic data were compared at baseline, before BPA, before PEA, and 6 months after PEA.
Results
We enrolled 61 patients, aged 61.9 ± 13.0 years, between 2017 and 2023. At baseline, mean pulmonary artery pressure (mPAP), cardiac output (CO), and pulmonary vascular resistance (PVR) were 49.0 ± 11.7 mmHg, 4.3 ± 1.2 L/min and 9.9 ± 4.0 WU, respectively. The most common complications were hemoptysis (13.1%) and pulmonary artery dissection (6.5%) for BPA and acute kidney injury (34.4%) and reperfusion pulmonary edema (31.1%) for PEA. The New York Heart Association functional class improved significantly and mPAP and PVR decreased significantly after each step of the strategy. Compared to baseline, the mPAP decrease was −49.4% ± 16.7% and the PVR decrease was −69.3% ± 15.9%. Three patients died in the first 2 months following surgery. The overall survival rate 14 months after PEA was 95%.
Conclusion
Our multimodal strategy was safe and effective in selected patients with severe CTEPH in whom upfront PEA was deemed unacceptably hazardous due to a high surgical risk and mixed anatomical lesions.
{"title":"Combined multimodal therapy in high-risk patients with chronic thromboembolic pulmonary hypertension and both distal and proximal lesions: A prospective observational cohort study","authors":"J.N. Andarelli , J. Issard , T. Lacoste-Palasset , I. Mallak , B. Gerardin , S. Dolidon , D. Fabre , G. Dauriat , T. Genty , D. Mitilian , O. Mercier , M. Jevnikar , X. Jaïs , M. Humbert , P. Brenot , E. Fadel","doi":"10.1016/j.healun.2025.08.011","DOIUrl":"10.1016/j.healun.2025.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Treatments for chronic thromboembolic pulmonary hypertension (CTEPH) include PH-specific pharmacotherapy (PHSP), balloon pulmonary angioplasty (BPA), and pulmonary endarterectomy (PEA). We evaluated a sequential multimodal strategy (SMS) combining PHSP, BPA, and PEA in selected high-surgical-risk patients with distal lesions in one lung and proximal lesions in the other.</div></div><div><h3>Methods</h3><div>In this prospective observational study, patients were selected to the SMS by a multidisciplinary panel, based on hemodynamic severity, location of lesions, and comorbidity profile. Characteristics and complications of procedures were collected. Clinical, laboratory, and hemodynamic data were compared at baseline, before BPA, before PEA, and 6 months after PEA.</div></div><div><h3>Results</h3><div>We enrolled 61 patients, aged 61.9 ± 13.0 years, between 2017 and 2023. At baseline, mean pulmonary artery pressure (mPAP), cardiac output (CO), and pulmonary vascular resistance (PVR) were 49.0 ± 11.7 mmHg, 4.3 ± 1.2 L/min and 9.9 ± 4.0 WU, respectively. The most common complications were hemoptysis (13.1%) and pulmonary artery dissection (6.5%) for BPA and acute kidney injury (34.4%) and reperfusion pulmonary edema (31.1%) for PEA. The New York Heart Association functional class improved significantly and mPAP and PVR decreased significantly after each step of the strategy. Compared to baseline, the mPAP decrease was −49.4% ± 16.7% and the PVR decrease was −69.3% ± 15.9%. Three patients died in the first 2 months following surgery. The overall survival rate 14 months after PEA was 95%.</div></div><div><h3>Conclusion</h3><div>Our multimodal strategy was safe and effective in selected patients with severe CTEPH in whom upfront PEA was deemed unacceptably hazardous due to a high surgical risk and mixed anatomical lesions.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 137-147"},"PeriodicalIF":6.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930212","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}
Pub Date : 2025-08-20DOI: 10.1016/j.healun.2025.07.036
Peter D. Cho BS , Hedwig Zappacosta BS , Joseph Song BA , John P. White BA , Stephanie McKay MPH , Donatello Telesca PhD , Malini Daniel MD , Abbas Ardehali MD
Background
This study aims to assess predictors and outcomes of severe primary graft dysfunction (PGD) in a contemporary United States cohort.
Methods
The United Network for Organ Sharing database was retrospectively reviewed for isolated adult heart transplant recipients (September 2023-March 2025). The population was stratified into severe PGD (left or biventricular dysfunction within 24 hours following transplantation that requires mechanical circulatory support [MCS]) and control cohorts (all other recipients). Predictors of severe PGD were identified using multivariable logistic regression. The severe PGD cohort was further classified into transient severe primary graft dysfunction (TPGD, MCS off by 72 hours) vs. persistent severe primary graft dysfunction (PPGD, remained on MCS at 72 hours). The Kaplan-Meier method was used to compare 3-month survival between groups.
Results
During the study interval, 5,097 heart transplant recipients were identified in the United States, with 6.6% (n = 338) developing severe PGD. Predictors for severe PGD included pretransplant extracorporeal membrane oxygenation (adjusted odds ratio [AOR]: 2.55, p < 0.001), hearts from donation after circulatory death (AOR: 2.13, p < 0.001), donor acidemia before procurement (AOR: 2.01, p < 0.001), and recipient history of sternotomy (AOR: 1.83, p < 0.001). The severe PGD group experienced lower 3-month survival than the control group (74.4% vs 96.8%, p < 0.001). Among severe PGD cases, 36.7% (n = 124) experienced TPGD and had higher 3 month survial than PPGD group (88.0% vs 67.2%, p < 0.001).
Conclusions
Severe PGD following heart transplantation is associated with high early mortality. Consideration of risk factors in donor and recipient matching may mitigate the incidence of severe PGD.
本研究旨在评估当代美国队列中严重原发性移植物功能障碍（PGD）的预测因素和结果。方法回顾性分析美国器官共享网络数据库中孤立的成人心脏移植受者（2023年9月- 2025年3月）。人群被分为严重PGD（移植后24小时内左室或双室功能障碍，需要机械循环支持[MCS]）和对照队列（所有其他接受者）。使用多变量逻辑回归确定严重PGD的预测因子。严重PGD组进一步分为短暂性严重原发性移植物功能障碍（TPGD， MCS关闭72小时）和持续性严重原发性移植物功能障碍（PPGD， 72小时仍在MCS上）。采用Kaplan-Meier法比较各组3个月生存率。结果在研究期间，美国共发现5097例心脏移植受者，其中6.6% （n = 338）发生严重PGD。严重PGD的预测因素包括移植前体外膜氧合（校正优势比[AOR]: 2.55, p < 0.001）、循环死亡后捐赠心脏（AOR: 2.13, p < 0.001）、供体获取前酸血症（AOR: 2.01, p < 0.001）和受体胸骨切开术史（AOR: 1.83, p < 0.001）。重度PGD组3个月生存率低于对照组（74.4% vs 96.8%, p < 0.001）。重度PGD患者中，36.7% （n = 124）发生了TPGD， 3个月生存率高于PPGD组（88.0% vs 67.2%, p < 0.001）。结论心脏移植术后严重PGD与高早期死亡率相关。考虑供体和受体匹配的危险因素可能会减轻严重PGD的发生率。
{"title":"Predictors and outcomes of severe primary graft dysfunction in heart transplantation: United States cohort analysis","authors":"Peter D. Cho BS , Hedwig Zappacosta BS , Joseph Song BA , John P. White BA , Stephanie McKay MPH , Donatello Telesca PhD , Malini Daniel MD , Abbas Ardehali MD","doi":"10.1016/j.healun.2025.07.036","DOIUrl":"10.1016/j.healun.2025.07.036","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to assess predictors and outcomes of severe primary graft dysfunction (PGD) in a contemporary United States cohort.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing database was retrospectively reviewed for isolated adult heart transplant recipients (September 2023-March 2025). The population was stratified into severe PGD (left or biventricular dysfunction within 24 hours following transplantation that requires mechanical circulatory support [MCS]) and control cohorts (all other recipients). Predictors of severe PGD were identified using multivariable logistic regression. The severe PGD cohort was further classified into transient severe primary graft dysfunction (TPGD, MCS off by 72 hours) vs. persistent severe primary graft dysfunction (PPGD, remained on MCS at 72 hours). The Kaplan-Meier method was used to compare 3-month survival between groups.</div></div><div><h3>Results</h3><div>During the study interval, 5,097 heart transplant recipients were identified in the United States, with 6.6% (<em>n</em> = 338) developing severe PGD. Predictors for severe PGD included pretransplant extracorporeal membrane oxygenation (adjusted odds ratio [AOR]: 2.55, <em>p</em> < 0.001), hearts from donation after circulatory death (AOR: 2.13, <em>p</em> < 0.001), donor acidemia before procurement (AOR: 2.01, <em>p</em> < 0.001), and recipient history of sternotomy (AOR: 1.83, <em>p</em> < 0.001). The severe PGD group experienced lower 3-month survival than the control group (74.4% vs 96.8%, <em>p</em> < 0.001). Among severe PGD cases, 36.7% (<em>n</em> = 124) experienced TPGD and had higher 3 month survial than PPGD group (88.0% vs 67.2%, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Severe PGD following heart transplantation is associated with high early mortality. Consideration of risk factors in donor and recipient matching may mitigate the incidence of severe PGD.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 16-25"},"PeriodicalIF":6.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930164","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}
Pub Date : 2025-08-20DOI: 10.1016/j.healun.2025.07.037
Salma Raghad Karim , Niels Møller Jensen , Emil Nielsen Holck , Tor Skibsted Clemmesen , Evald Høj Christiansen , Lars Jakobsen , Zhi Chen , Milan Sonka , Kristjan Karason , Kaspar Broch , Ole Geir Solberg , Hans Eiskjær
Background
Cardiac allograft vasculopathy, characterized by arterial intima thickening and microvascular dysfunction, compromises survival after heart transplantation. We investigated the impact of evolocumab on invasive coronary physiology and microstructure after de-novo transplantation.
Methods
In the EVOLVD trial (NCT03734211), the effect of 12 months of evolocumab vs placebo on maximal coronary intimal thickness was assessed using intracoronary ultrasound. For this substudy, optical coherence tomography (OCT), fractional flow reserve (FFR), coronary flow reserve (CFR), microvascular resistance reserve (MRR), and index of microcirculatory resistance (IMR) were performed at baseline (4-8 weeks post-transplant) and at 12 months post-transplant.
Results
Seventy-five de-novo heart transplant recipients were included, randomized to placebo (n = 36) or evolocumab (n = 39). Over 12 months, no between-group differences were observed in changes in coronary physiology (FFR: Δ 0.001 [IQR −0.03 to 0.02], p = 0.42; CFR: Δ 0.59 [IQR −1.33 to 1.90], p = 0.69; IMR: Δ 0.76 [IQR −6.86 to 8.32], p = 0.09; MRR: Δ 0.19 [IQR −1.85 to 2.60], p = 0.70) or coronary microstructure (lumen area: Δ −1.37 mm² [IQR −3.53 to 0.09], p = 0.38; intima area: Δ 0.05 mm² [IQR 0.02 to 0.17], p = 0.88. Among all patients, OCT showed a lumen area decrease of −1.37 [IQR −3.53 to −0.69] mm² (p < 0.01) and intima area increasse of 0.04 [IQR 0.01 to 0.17] mm² (p < 0.01) from baseline to follow-up.
Conclusions
Evolocumab did not affect coronary physiology or OCT measurements 12 months after de-novo heart transplantation. OCT revealed progressive intimal proliferation and luminal narrowing in both groups, while coronary physiology remained unchanged and did not differ between treatment arms.
{"title":"Impact of evolocumab on coronary physiology and microstructure in de-novo heart transplant recipients","authors":"Salma Raghad Karim , Niels Møller Jensen , Emil Nielsen Holck , Tor Skibsted Clemmesen , Evald Høj Christiansen , Lars Jakobsen , Zhi Chen , Milan Sonka , Kristjan Karason , Kaspar Broch , Ole Geir Solberg , Hans Eiskjær","doi":"10.1016/j.healun.2025.07.037","DOIUrl":"10.1016/j.healun.2025.07.037","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac allograft vasculopathy, characterized by arterial intima thickening and microvascular dysfunction, compromises survival after heart transplantation. We investigated the impact of evolocumab on invasive coronary physiology and microstructure after de-novo transplantation.</div></div><div><h3>Methods</h3><div>In the EVOLVD trial (NCT03734211), the effect of 12 months of evolocumab vs placebo on maximal coronary intimal thickness was assessed using intracoronary ultrasound. For this substudy, optical coherence tomography (OCT), fractional flow reserve (FFR), coronary flow reserve (CFR), microvascular resistance reserve (MRR), and index of microcirculatory resistance (IMR) were performed at baseline (4-8 weeks post-transplant) and at 12 months post-transplant.</div></div><div><h3>Results</h3><div>Seventy-five de-novo heart transplant recipients were included, randomized to placebo (<em>n</em> = 36) or evolocumab (<em>n</em> = 39). Over 12 months, no between-group differences were observed in changes in coronary physiology (FFR: Δ 0.001 [IQR −0.03 to 0.02], <em>p</em> = 0.42; CFR: Δ 0.59 [IQR −1.33 to 1.90], <em>p</em> = 0.69; IMR: Δ 0.76 [IQR −6.86 to 8.32], <em>p</em> = 0.09; MRR: Δ 0.19 [IQR −1.85 to 2.60], <em>p</em> = 0.70) or coronary microstructure (lumen area: Δ −1.37 mm² [IQR −3.53 to 0.09], <em>p</em> = 0.38; intima area: Δ 0.05 mm² [IQR 0.02 to 0.17], <em>p</em> = 0.88. Among all patients, OCT showed a lumen area decrease of −1.37 [IQR −3.53 to −0.69] mm² (<em>p</em> < 0.01) and intima area increasse of 0.04 [IQR 0.01 to 0.17] mm² (<em>p</em> < 0.01) from baseline to follow-up.</div></div><div><h3>Conclusions</h3><div>Evolocumab did not affect coronary physiology or OCT measurements 12 months after de-novo heart transplantation. OCT revealed progressive intimal proliferation and luminal narrowing in both groups, while coronary physiology remained unchanged and did not differ between treatment arms.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 26-36"},"PeriodicalIF":6.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930162","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}
Pub Date : 2025-08-20DOI: 10.1016/j.healun.2025.08.010
Anthony P. Carnicelli MD , Shashank S. Sinha , Song Li MD , Borui Li , Michele Esposito MD , Rachna Kataria MD , Arthur R. Garan MD , Van-Khue Ton MD PhD , Kevin John MD , Elric Zweck MD , Jaime Hernandez-Montfort MD , Jacob Abraham MD , Daniel Burkhoff MD PhD , Manreet K. Kanwar MD , Navin K. Kapur MD , On Behalf of the Cardiogenic Shock Working Group Academic Consortium
Background
Impella CP (Abiomed, Danvers, MA) microaxial flow pumps are commonly used in acute myocardial infarction (AMI) and heart failure (HF) cardiogenic shock (CS). Contemporary data from large, unselected populations are needed to understand differences between these groups.
Methods
The Cardiogenic Shock Working Group registry enrolls patients with CS at 36 international sites. We analyzed patients with Impella CP enrolled from 2019-2024, categorized by CS etiology and mechanical support device exposure. Baseline characteristics, complications, and outcomes were compared. Outcomes included survival to discharge, native heart survival, and heart replacement therapy. Multivariable analysis was performed to identify predictors of in-hospital mortality and complications.
Results
A total of 1,486 patients with CS (57.9% AMI-CS, 34.9% HF-CS) and Impella CP were analyzed. Patients with HF-CS were younger (60 vs 64 years; p < 0.001) and more likely to have chronic kidney disease (26.4% vs 13.6; p < 0.001) than those with AMI-CS. Impella CP alone was used in 38.3%, CP+ extracorporeal membrane oxygenation in 23.1%, and CP + ≥2 other devices in 20.4%. Acute kidney injury was more common in HF-CS than AMI-CS (66.5% vs 59.7%, p = 0.03) and acute limb ischemia more common in AMI-CS than HF-CS (14.4% vs 11.0%; p = 0.05). Survival to discharge was 53.4% and was higher in HF-CS than AMI-CS (59.7% vs 49.8%; p < 0.001). Those with ≥2 other devices had the lowest survival (43.8%). Total device number was significantly associated with in-hospital mortality, limb ischemia, and bleeding.
Conclusions
Differences in baseline characteristics, device exposure, and hospital complications between patients with HF-CS and AMI-CS supported by Impella CP may influence outcomes.
目的impella CP （Abiomed, Danvers， MA）微轴流泵常用于急性心肌梗死（AMI）和心力衰竭（HF）心源性休克（CS）。要了解这些群体之间的差异，需要来自大量未选择人群的当代数据。方法心源性休克工作组（CSWG）登记了36个国际站点的CS患者。我们分析了2019-2024年入组的Impella CP患者，根据CS病因和机械支持装置暴露进行分类。比较基线特征、并发症和结果。结果包括存活至出院、原生心脏存活和心脏替代治疗。进行多变量分析以确定院内死亡率和并发症的预测因素。结果共分析1486例CS （AMI-CS占57.9%，HF-CS占34.9%）和Impella CP患者。与AMI-CS相比，HF-CS患者更年轻（60岁vs 64岁，p<0.001），更容易发生慢性肾脏疾病（26.4% vs 13.6%, p<0.001）。单独使用Impella CP的占38.3%，使用CP+ECMO的占23.1%，使用CP+≥2个其他装置的占20.4%。AMI-CS比AMI-CS更常见急性肾损伤（66.5%比59.7%,p=0.03）， AMI-CS比HF-CS更常见急性肢体缺血（14.4%比11.0%,p=0.05）。到出院的生存率为53.4%，HF-CS高于AMI-CS （59.7% vs 49.8%; p<0.001）。其他器械≥2种的患者生存率最低（43.8%）。总装置数量与住院死亡率、肢体缺血和出血显著相关。结论：Impella CP支持的HF-CS和AMI-CS患者在基线特征、器械暴露和医院并发症方面的差异可能会影响结果。
{"title":"Outcomes with Impella CP in acute myocardial infarction vs heart failure cardiogenic shock: Insights from the Cardiogenic Shock Working Group","authors":"Anthony P. Carnicelli MD , Shashank S. Sinha , Song Li MD , Borui Li , Michele Esposito MD , Rachna Kataria MD , Arthur R. Garan MD , Van-Khue Ton MD PhD , Kevin John MD , Elric Zweck MD , Jaime Hernandez-Montfort MD , Jacob Abraham MD , Daniel Burkhoff MD PhD , Manreet K. Kanwar MD , Navin K. Kapur MD , On Behalf of the Cardiogenic Shock Working Group Academic Consortium","doi":"10.1016/j.healun.2025.08.010","DOIUrl":"10.1016/j.healun.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Impella CP (Abiomed, Danvers, MA) microaxial flow pumps are commonly used in acute myocardial infarction (AMI) and heart failure (HF) cardiogenic shock (CS). Contemporary data from large, unselected populations are needed to understand differences between these groups.</div></div><div><h3>Methods</h3><div>The Cardiogenic Shock Working Group registry enrolls patients with CS at 36 international sites. We analyzed patients with Impella CP enrolled from 2019-2024, categorized by CS etiology and mechanical support device exposure. Baseline characteristics, complications, and outcomes were compared. Outcomes included survival to discharge, native heart survival, and heart replacement therapy. Multivariable analysis was performed to identify predictors of in-hospital mortality and complications.</div></div><div><h3>Results</h3><div>A total of 1,486 patients with CS (57.9% AMI-CS, 34.9% HF-CS) and Impella CP were analyzed. Patients with HF-CS were younger (60 vs 64 years; <em>p</em> < 0.001) and more likely to have chronic kidney disease (26.4% vs 13.6; <em>p</em> < 0.001) than those with AMI-CS. Impella CP alone was used in 38.3%, CP+ extracorporeal membrane oxygenation in 23.1%, and CP + ≥2 other devices in 20.4%. Acute kidney injury was more common in HF-CS than AMI-CS (66.5% vs 59.7%, <em>p</em> = 0.03) and acute limb ischemia more common in AMI-CS than HF-CS (14.4% vs 11.0%; <em>p</em> = 0.05). Survival to discharge was 53.4% and was higher in HF-CS than AMI-CS (59.7% vs 49.8%; <em>p</em> < 0.001). Those with ≥2 other devices had the lowest survival (43.8%). Total device number was significantly associated with in-hospital mortality, limb ischemia, and bleeding.</div></div><div><h3>Conclusions</h3><div>Differences in baseline characteristics, device exposure, and hospital complications between patients with HF-CS and AMI-CS supported by Impella CP may influence outcomes.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 262-272"},"PeriodicalIF":6.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930161","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}
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