Journal of Heart and Lung Transplantation最新文献

{"title":"Ex-vivo heart perfusion attenuates early post-transplant risk after prolonged agonal period in DCD heart transplantation","authors":"Alexander R. Berg BS,&nbsp;Aravind Krishnan MD,&nbsp;Elbert E. Heng MD,&nbsp;Ashley Y. Choi MD, MHS,&nbsp;Alyssa C. Garrison MS,&nbsp;Daniel I. Alnasir BS,&nbsp;Chawannuch Ruaengsri MD,&nbsp;Yasuhiro Shudo MD, PHD,&nbsp;Y. Joseph Woo MD,&nbsp;John W. MacArthur MD","doi":"10.1016/j.healun.2025.10.012","DOIUrl":"10.1016/j.healun.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Warm ischemic injury during the agonal period (AP) threatens graft viability in donation-after-circulatory-death (DCD) heart transplantation. Whether ex vivo heart perfusion (EVHP) mitigates these risks remains unclear.</div></div><div><h3>Methods</h3><div>Adult (≥18 years) isolated heart transplants reported to the United Network for Organ Sharing (UNOS) thoracic registry (January 2019-April 2025) were reviewed. Recipients lacking AP or perfusion data were excluded. The primary exposure was EVHP, defined as use of an ex vivo perfusion device following donor cardiectomy; static cold storage served as the reference. Multivariable Cox and logistic models adjusted for donor, recipient, procedural, and center-level factors. Propensity score matching was performed in the prolonged AP subgroup.</div></div><div><h3>Results</h3><div>Among 1,682 donation after circulatory death (DCD) recipients, 1,175 (69.9%) received ex vivo heart perfusion (EVHP). Prolonged AP (≥30 min) occurred in 359 cases. One-year survival was 90.7% overall. In the fully adjusted Cox model, no-EVHP grafts with AP ≥30 min had higher 1-year mortality versus the reference (no-EVHP + &lt;30 min) (HR 2.17; 95% CI 1.05-4.47; <em>p</em> = 0.037). EVHP grafts showed no excess risk regardless of AP (EVHP + &lt;30 min: HR 0.93; 95% CI 0.54-1.62; <em>p</em> = 0.809; EVHP + ≥30 min: HR 0.98; 95% CI 0.49-1.96; <em>p</em> = 0.953). Age, creatinine, out-of-body time, and adult congenital heart disease (ACHD) increased mortality; ventricular assist device (VAD) at listing and high-volume centers were protective; sex was not significant. In the AP ≥30-min propensity score matching (PSM) subgroup (<em>n</em> = 240; 120 EVHP, 120 no EVHP), EVHP improved 1-year survival (log-rank <em>p</em> = 0.03). Spline modeling showed rising mortality beginning ∼20 min of AP for static-preserved grafts, with a flat risk curve under EVHP. Static-preserved prolonged-AP grafts had higher odds of acute rejection before discharge (aOR 2.56; 95% CI 1.07-6.14; <em>p</em> = 0.04); stroke, dialysis, and pacemaker use did not differ.</div></div><div><h3>Conclusions</h3><div>EVHP may mitigate survival and rejection penalties of prolonged AP in the U.S. DCD heart transplantation. Broader EVHP adoption for donors with AP ≥30 min may safely expand the DCD heart pool without compromising outcomes.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 337-346"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525114","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}

{"title":"Outcomes of BK in simultaneous heart kidney transplant: A 3 center experience","authors":"Alex Nica MD ,&nbsp;Suman Misra MD ,&nbsp;D. Eric Steidley MD ,&nbsp;Joseph Hentz MS ,&nbsp;Erin Graf PhD ,&nbsp;Maxwell Smith MD ,&nbsp;Parag Patel MD ,&nbsp;Samy Riad MD ,&nbsp;Hani M. Wadei MD ,&nbsp;Girish Mour MD","doi":"10.1016/j.healun.2025.10.007","DOIUrl":"10.1016/j.healun.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>BK polyomavirus DNAemia is common in solitary kidney transplants (KTs), with the risk of developing BK DNAemia-associated nephropathy, but data is limited in simultaneous heart-KTs. Our aim was to assess the prevalence and outcomes of BK DNAemia after simultaneous heart-KT.</div></div><div><h3>Methods</h3><div>Retrospective study between January 1, 2005, and June 30, 2022, analyzing the prevalence of BK DNAemia and BK DNAemia-associated nephropathy rates in simultaneous heart-KT recipients between BK DNAemia positive and BK DNAemia negative groups. Secondary outcomes included heart and kidney allograft function, kidney allograft survival, rejection rates, and patient survival.</div></div><div><h3>Results</h3><div>Thirty-eight percent developed BK DNAemia, while 47% of patients with BK DNAemia developed BK DNAemia-associated nephropathy. The median time to first detection of BK DNAemia was 86 days (IQR: 50-118 days) and resolution was 216 days (IQR: 106-366 days). The BK DNAemia positive group had significantly higher kidney rejection rates (47% vs 25%; <em>p</em> = 0.01). There was no significant difference in patient survival (<em>p</em> = 0.7) or allograft function of either allograft between the two groups. Immunosuppression was reduced more frequently in the BK DNAemia positive group (84% vs 46%; <em>p</em> &lt; 0.001). There was an increased risk of subsequent kidney rejection in patients who developed BK DNAemia (<em>p</em> = 0.024).</div></div><div><h3>Conclusion</h3><div>BK DNAemia and BK DNAemia-associated nephropathy are common in simultaneous heart-kidney recipients, leading to increased kidney rejection rates without affecting overall patient survival or allograft kidney and heart function.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 475-484"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331750","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}

{"title":"A New Frontier of HIV Organ Policy Equity − Expanding the transplant donor pool","authors":"Isabel C. Balachandran MD ,&nbsp;Ruth O. Adekunle MD, MSCR","doi":"10.1016/j.healun.2025.10.030","DOIUrl":"10.1016/j.healun.2025.10.030","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 473-474"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516247","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}

{"title":"Early experience in heart transplantation utilizing donors with HIV","authors":"Omar Saeed MD, MSc ,&nbsp;Vagish Hemmige MD, MSc ,&nbsp;Lorenzo D’ Angelo MD ,&nbsp;Christiana Gjelaj NP ,&nbsp;Yoram A. Puius MD, PhD ,&nbsp;Shivank Madan MD ,&nbsp;Yogita Rochlani MD ,&nbsp;Julia Shin MD ,&nbsp;Daniel B. Sims MD ,&nbsp;Daniel J. Goldstein MD ,&nbsp;Ulrich P. Jorde MD ,&nbsp;Snehal R. Patel MD","doi":"10.1016/j.healun.2025.09.011","DOIUrl":"10.1016/j.healun.2025.09.011","url":null,"abstract":"<div><div>The use of organs between donors and recipients with Human Immunodeficiency Virus (HIV) in solid organ transplantation is an area of growing interest. We conducted a single center observational study to compare early outcomes after heart transplantation (HTx) in HIV-positive recipients using HIV-positive or HIV-negative donors. Overall, 10 HIV-positive recipients underwent HTx, with 4 receiving HIV-positive and 6 receiving HIV-negative organs. At 6 months, both groups had similar survival (100% vs 100%, <em>p</em> = 1.00), episodes of rejection (0, 0–0.5 vs 0, 0–1, <em>p</em> = 0.69) and infection (0, 0.5–3 vs 1, 1–2, <em>p</em> = 0.25) per patient, HIV suppression with antiretroviral therapy (VL &lt;25 copies/ml or undetectable: 100% vs 100%, <em>p</em> = 1.00) and donor derived cell free DNA (0.07, 0.05–0.10% vs 0.13, 0.12–0.15%, <em>p</em> = 0.11). These data provide early evidence supporting the feasibility of utilizing organs from donors with HIV for HTx in recipients with HIV.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 468-472"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140260","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}

{"title":"Bloodless combined heart-kidney transplant in a patient bridged to transplant with an axillary temporary left ventricular assist device,","authors":"Mohamed Abdullah ,&nbsp;Ahmed Sedeek ,&nbsp;Michael L. Boisen ,&nbsp;Gavin Hickey ,&nbsp;Mary Keebler ,&nbsp;Vikraman Gunabushanam ,&nbsp;David J. Kaczorowski M.D.","doi":"10.1016/j.healun.2025.10.013","DOIUrl":"10.1016/j.healun.2025.10.013","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 519-521"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319182","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}

{"title":"Timing of quality of life and lung function changes during the first year following lung transplantation: A multicenter prospective cohort study","authors":"Wayne M. Tsuang MD, PhD ,&nbsp;Megan L. Neely PhD ,&nbsp;Lianne G. Singer MD ,&nbsp;John A. Belperio MD ,&nbsp;Marie Budev DO ,&nbsp;Courtney W. Frankel PT, MS ,&nbsp;Jerry Kirchner BS ,&nbsp;Scott M. Palmer MD, MHS ,&nbsp;John M. Reynolds MD ,&nbsp;Jamie L. Todd MD, MHS ,&nbsp;S. Sam Weigt MD, MS ,&nbsp;Laurie D. Snyder MD, MHS","doi":"10.1016/j.healun.2025.09.024","DOIUrl":"10.1016/j.healun.2025.09.024","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation (LT) has been shown to improve lung function and quality of life (QoL). We sought to clarify if QoL improvements coincide with improvements in spirometry assessments in the first post-transplant year.</div></div><div><h3>Methods</h3><div>In the multicenter observational Clinical Trials in Organ Transplantation-20 study, LT recipients had longitudinal forced expiratory volume in 1 second (FEV1) and QoL measurements, specifically the St. George’s Respiratory Questionnaire (SGRQ) and 36-Item Short Form Survey (SF-36), collected at 1, 3, 6, 9, and 12 months post-LT. We assessed whether best QoL scores occurred before, simultaneously, or after best FEV1.</div></div><div><h3>Results</h3><div>Of 803 recipients, 702 met the inclusion criteria. The best total SGRQ score occurred before best FEV1 in 16.0% of patients, simultaneously in 28.3%, and afterward in 55.7%. Similarly, the best SF-36 physical score occurred before best FEV1 in 18.7% of patients, simultaneously in 32.7%, and afterward in 48.6%. Single LTs, age &gt;65 years, male sex, and diagnosis other than cystic lung disease were associated with a higher likelihood of achieving best QoL after best FEV1.</div></div><div><h3>Conclusions</h3><div>Both spirometry and multiple physical and social QoL domains improved over the first post-LT year, but these improvements did not necessarily occur simultaneously. Nearly half of patients reached their best respiratory-specific and physical QoL scores after best FEV1; however, timing varied by recipient characteristics. As the pace of post-LT recovery is multifactorial, our findings provide insights to patients and providers regarding anticipated post-transplant changes and highlight the importance of considering both spirometry and QoL measures.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 430-439"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254485","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}

{"title":"Sex-biased immune rewiring may underlie reduced risk for cardiac allograft vasculopathy in females following heart transplantation","authors":"Kyle Saysana MD ,&nbsp;Nelson Chow BS ,&nbsp;Shi Huang PhD ,&nbsp;Benjamin French MD ,&nbsp;Raymond Dieter MD ,&nbsp;Ayeshia Ali BS ,&nbsp;Eric Farber-Eger BS ,&nbsp;Quinn S. Wells MD, PharmD ,&nbsp;Hasan K. Siddiqi MD ,&nbsp;David W. Bearl MD ,&nbsp;Kelly H. Schlendorf MD, MHS ,&nbsp;Kaushik Amancherla MD, MSCI","doi":"10.1016/j.healun.2025.11.022","DOIUrl":"10.1016/j.healun.2025.11.022","url":null,"abstract":"<div><h3>Background</h3><div>Uncovering sex-based differences in immunologic outcomes following heart transplantation (HT) can inform risk stratification and precision immunosuppressive strategies. However, granular clinical-translational understanding of sex-specific molecular risk in the modern era is lacking. Here, we investigate the relationship between sex, acute rejection, and cardiac allograft vasculopathy (CAV) in adults and children following HT. We then decode cell-specific gene expression patterns in healthy individuals and HT recipients to identify discordant pathways that inform immunologic risk.</div></div><div><h3>Methods</h3><div>We studied 833 adult and pediatric HT recipients to delineate the risk of donor-specific antibody (DSA) formation, acute rejection, and angiographic CAV between males and females. Next, using publicly available single-cell RNA-sequencing (scRNA-seq) data in circulating immune cells of healthy individuals (<em>N</em> = 981) and an HT-specific scRNA-seq dataset (<em>N</em> = 40), we conducted sex-stratified differential gene expression and functional enrichment analyses.</div></div><div><h3>Results</h3><div>Among 833 HT recipients (694 adults, 139 children; overall 32.8% female), no significant differences in acute rejection were identified between males and females. Adult females were less likely to develop angiographic CAV (HR 0.58, 95% CI 0.42-0.79). In healthy individuals, scRNA-seq recapitulated enrichment for broad autoimmune/inflammatory pathways in females. However, this was inverted following HT, with male recipients exhibiting upregulation translational/ribosomal machinery and cytokine sensing/signaling in a cell-specific fashion, along with enrichment for autoimmune disease pathways. CAV-associated gene sets were preferentially male-skewed in memory T cells.</div></div><div><h3>Discussion</h3><div>Despite similar rates of acute rejection, adult females were less likely to develop angiographic CAV. Differences between healthy and post-HT individuals identified molecular biases that may drive chronic low-grade inflammation, favoring CAV development in males. Additional studies are needed to validate these findings.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 365-374"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592838","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}

{"title":"Molecular biopsy features associated with baseline lung allograft dysfunction in a multicenter international cohort","authors":"Martina Mackova PhD ,&nbsp;Patrick Gauthier PhD ,&nbsp;Jessica Chang BSc ,&nbsp;Alim Hirji MD MSc ,&nbsp;Justin Weinkauf MD ,&nbsp;Stephen Juvet MD, PhD ,&nbsp;Shaf Keshavjee MD, MSc ,&nbsp;Jan Havlin MD, PhD ,&nbsp;Robert Lischke MD, PhD ,&nbsp;Andrea Zajacova MD ,&nbsp;Greg Snell MBBS, FRACP MD ,&nbsp;Glen Westall MBBS FRACP PhD, PhD ,&nbsp;Philip F. Halloran MD, PhD ,&nbsp;Kieran Halloran MD, MSc","doi":"10.1016/j.healun.2025.11.005","DOIUrl":"10.1016/j.healun.2025.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Baseline lung allograft dysfunction (BLAD) is a state of abnormally low peak post-transplant lung function, but the mechanisms are poorly understood. In this study, we examined transbronchial biopsy (TBB) gene expression changes associated with BLAD in an international cohort of prospectively enrolled lung transplant recipients.</div></div><div><h3>Methods</h3><div>BLAD status was assessed at 1-year post-transplant and defined as failure to reach normal lung function, as defined by a forced expiratory volume in 1 s and a forced vital capacity &gt; 80% predicted on two consecutive occasions &gt; 3 weeks apart. We used genome-wide microarray measurements in 252 TBBs obtained during the first post-transplant year from 214 double lung transplant recipients to identify top genes and pathogenesis-based transcript sets in BLAD and develop a molecular BLAD classifier.</div></div><div><h3>Results</h3><div>BLAD at 1-year post-transplant was diagnosed in 41% of patients and was more frequent in patients with interstitial lung disease (ILD) as transplant indication. TBBs from patients with BLAD showed increased transcripts associated with T cell-mediated rejection (TCMR) and cytotoxic T cell burden. BLAD biopsies were more likely to be classified as TCMR archetype – despite no differences in histology – and low surfactant archetype and less likely to be classified as no rejection. A molecular classifier developed to predict BLAD showed modest performance (AUC 0.58), which improved to 0.64 with the inclusion of clinical variables.</div></div><div><h3>Conclusions</h3><div>TBBs obtained during the first post-transplant year from patients with BLAD exhibit more frequent molecular features of TCMR not detected by histology, suggesting undetected or undertreated rejection may be contributing to poorer post-transplant lung function.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 403-414"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531216","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}

{"title":"Warm ischemia and heart transplantation","authors":"Martin Strueber","doi":"10.1016/j.healun.2025.11.001","DOIUrl":"10.1016/j.healun.2025.11.001","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 347-349"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145567309","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}

{"title":"Beyond the edge","authors":"Cristiano Amarelli MD","doi":"10.1016/j.healun.2025.11.027","DOIUrl":"10.1016/j.healun.2025.11.027","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 334-336"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689532","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}