Journal of Heart and Lung Transplantation最新文献

Hypothermic oxygenated perfusion (HOPE) is an emerging technique for donor heart preservation that is currently being studied in multiple clinical trials with promising results. When compared to HOPE for other organs, cardiac protocols involve red blood cell (RBC) supplementation, despite absence of comparative evidence for its benefits. In this perspective paper, we discuss the pros and cons of the addition of RBCs during cardiac HOPE. Although the current clinical results with RBC supplementation during HOPE seem promising, potential downsides of RBC supplementation cannot be ruled out. The impact of supplemented RBCs during cardiac HOPE requires further investigation to improve HOPE protocols, to optimize heart preservation using this promising technology.

Background: There is limited evidence to support treatment recommendations in patients with pulmonary arterial hypertension (PAH) and comorbidities. To investigate the impact of riociguat treatment in this patient population, we analyzed pooled data from randomized controlled trials of riociguat.

Methods: This post hoc analysis included data from the PATENT-1, PATENT-2, PATENT PLUS, and REPLACE studies. Safety, efficacy (6-minute walk distance [6MWD], World Health Organization functional class [WHO-FC], and N-terminal probrain natriuretic peptide [NT-proBNP]), and COMPERA 2.0 risk status were assessed in patients with 0, 1 to 2, or 3 to 4 cardiometabolic comorbidities (obesity, systemic hypertension, diabetes mellitus, coronary artery disease) in the main phase of the studies. Safety was also assessed in the long-term extensions.

Results: The analysis included 686 patients (riociguat, n = 440; placebo, n = 132; phosphodiesterase type 5 inhibitors [PDE5i], n = 114), of whom 55%, 39%, and 6% had 0, 1 to 2, and 3 to 4 comorbidities, respectively. In the main phase, rates and severity of adverse events (AEs) were similar in riociguat-treated patients across comorbidity subgroups. After 2 years, discontinuations of riociguat due to AEs were also similar across subgroups. Compared with placebo and PDE5i, riociguat improved 6MWD and NT-proBNP across comorbidity groups and improved WHO-FC and COMPERA 2.0 risk status in patients with 0 or 1 to 2 comorbidities.

Conclusions: Riociguat had an acceptable safety profile in PAH patients with cardiometabolic comorbidities. Efficacy and risk assessment results suggest that riociguat can be beneficial for patients with PAH, irrespective of the presence of comorbidities.

Background: In pediatric living-donor lobar lung transplantation, whether transplanting adult lobes could result in satisfactory long-term survival and respiratory functional outcomes during and after the growth period in pediatric patients remains unclear. This study aimed to evaluate the long-term survival and functional prognosis after pediatric living-donor lobar lung transplantation and deceased-donor lung transplantation.

Methods: We retrospectively reviewed clinical data of pediatric patients (age: ≤17 years) who underwent lung transplantation between March 2001 and December 2022 at three institutions in Japan.

Results: Seventy and 24 patients who underwent living-donor and deceased-donor transplantation, respectively, were included. The 5-year and 10-year overall survival rates were 84.6% and 75.0% after living-donor transplantation and 85.8% and 85.8% after deceased-donor transplantation (p = 0.75), respectively. With a median follow-up period of 89.2 months, 48 living-donor cases (100%) and 16 deceased-donor cases (84.2%) had performance status 0-2 among 48 living-donor cases and 19 deceased-donor cases who were alive without re-transplantation. They showed height growth (median +9.7 cm, p < 0.01); however, the height standard deviation score decreased after transplantation (median -0.22, p = 0.03). The difference in height standard deviation score between the last follow-up and pre-transplantation was negative (median -0.42) in living-donor cases and significantly smaller than that in deceased-donor cases (median +0.19, p = 0.02).

Conclusions: Pediatric living-donor lobar lung transplantation provided satisfactory long-term survival and functional prognosis that were comparable to those of deceased-donor lung transplantation. The limited post-transplant height growth in living-donor cases might be attributed to this favorable functional prognosis.