Pub Date : 2026-03-01Epub Date: 2025-11-29DOI: 10.1016/j.healun.2025.11.032
Eileen M. Hsich MD , Marc K. Halushka MD, PhD
{"title":"Multimodal molecular testing for heart transplant recipients—is it actionable yet?","authors":"Eileen M. Hsich MD , Marc K. Halushka MD, PhD","doi":"10.1016/j.healun.2025.11.032","DOIUrl":"10.1016/j.healun.2025.11.032","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 401-402"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619568","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 : 2026-03-01Epub Date: 2025-10-08DOI: 10.1016/j.healun.2025.09.021
Angélique Leclerc , Isabelle Danner-Boucher , Alexandre Walencik , Béatrice Guyomarch , Charlotte Bry , Vincent Dochez , Jérôme Le Pavec , Olivier Brugière , Martine Reynaud-Gaubert , Benjamin Coiffard , Romain Kessler , Xavier Demant , Julie Macey , Claire Merveilleux du Vignaux , Christel Saint -Raymond , Pierre-Régis Burgel , Nicolas Carlier , Jacqueline Silleran-Chassany , Betsega Assefa Bayeh , François-Xavier Blanc , Adrien Tissot
Background
Pregnancies in women with lung transplants are considered high-risk due to comorbidities. There is a risk of pregnancy–related antihuman leukocyte antigen alloimmunization, which can potentially lead to antibody-mediated rejection in transplant patients. A few such cases have been reported in women receiving kidney, liver, or heart transplants, but this risk has never been studied in lung transplantation. The aim of our study was to investigate the risk of developing antibody-mediated rejection in the year following pregnancy.
Methods
This is a multicenter retrospective study carried out in 11 French lung transplant centers. We included lung transplant recipients who had a pregnancy between January 1, 2012 and December 31, 2021.
Results
Seventy-six pregnancies were included in 52 patients. These were mainly women with double lung transplantation (n = 43; 82.7%). Cystic fibrosis (n = 40; 76.9%) and pulmonary hypertension (n = 11; 21%) were the main underlying diseases for transplantation. Of the 76 pregnancies, 43 (56.6%) resulted in the birth of live children, while the others resulted in abortion (n = 8; 10.5%) or miscarriage (n = 25; 32.9%). Five antibody-mediated rejections (6.6%) were identified in the year following pregnancy, with a mean time of 6.24 ± 6.02 months between the end of pregnancy and rejection. All 5 rejections resulted in graft loss, of which 2 deaths and 3 retransplantations. Nineteen pregnancies (25%) resulted in alloimmunization. When antihuman leukocyte antigen antibodies were de novo donor-specific antibodies (n = 5), antibody-mediated rejection occurred in all cases.
Conclusions
Pregnancy in female lung transplant recipients appears to be at risk of humoral rejection in the year following pregnancy.
{"title":"Pregnancy after lung transplantation: TRIGGER study on antihuman leukocyte antigen alloimmunization and antibody-mediated rejection risk","authors":"Angélique Leclerc , Isabelle Danner-Boucher , Alexandre Walencik , Béatrice Guyomarch , Charlotte Bry , Vincent Dochez , Jérôme Le Pavec , Olivier Brugière , Martine Reynaud-Gaubert , Benjamin Coiffard , Romain Kessler , Xavier Demant , Julie Macey , Claire Merveilleux du Vignaux , Christel Saint -Raymond , Pierre-Régis Burgel , Nicolas Carlier , Jacqueline Silleran-Chassany , Betsega Assefa Bayeh , François-Xavier Blanc , Adrien Tissot","doi":"10.1016/j.healun.2025.09.021","DOIUrl":"10.1016/j.healun.2025.09.021","url":null,"abstract":"<div><h3>Background</h3><div>Pregnancies in women with lung transplants are considered high-risk due to comorbidities. There is a risk of pregnancy–related antihuman leukocyte antigen alloimmunization, which can potentially lead to antibody-mediated rejection in transplant patients. A few such cases have been reported in women receiving kidney, liver, or heart transplants, but this risk has never been studied in lung transplantation. The aim of our study was to investigate the risk of developing antibody-mediated rejection in the year following pregnancy.</div></div><div><h3>Methods</h3><div>This is a multicenter retrospective study carried out in 11 French lung transplant centers. We included lung transplant recipients who had a pregnancy between January 1, 2012 and December 31, 2021.</div></div><div><h3>Results</h3><div>Seventy-six pregnancies were included in 52 patients. These were mainly women with double lung transplantation (<em>n</em> = 43; 82.7%). Cystic fibrosis (<em>n</em> = 40; 76.9%) and pulmonary hypertension (<em>n</em> = 11; 21%) were the main underlying diseases for transplantation. Of the 76 pregnancies, 43 (56.6%) resulted in the birth of live children, while the others resulted in abortion (<em>n</em> = 8; 10.5%) or miscarriage (<em>n</em> = 25; 32.9%). Five antibody-mediated rejections (6.6%) were identified in the year following pregnancy, with a mean time of 6.24 ± 6.02 months between the end of pregnancy and rejection. All 5 rejections resulted in graft loss, of which 2 deaths and 3 retransplantations. Nineteen pregnancies (25%) resulted in alloimmunization. When antihuman leukocyte antigen antibodies were de novo donor-specific antibodies (<em>n</em> = 5), antibody-mediated rejection occurred in all cases.</div></div><div><h3>Conclusions</h3><div>Pregnancy in female lung transplant recipients appears to be at risk of humoral rejection in the year following pregnancy.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 417-427"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261401","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 : 2026-03-01Epub Date: 2025-11-24DOI: 10.1016/j.healun.2025.11.014
David P. Jenkins MB BS. , Sofija Cerovic M.D., MSc , Dénes Csonka PharmD, PhD , Hossein-Ardeschir Ghofrani M.D. , Stefan Guth M.D. , Gustavo A. Heresi M.D. , Marc Humbert M.D, PhD. , Noormaa Jaumdally MSc , Zhi-Cheng Jing M.D. , Gabriela Lack PhD, MSc Pharm , Michael M. Madani M.D., FACS , Hiromi Matsubara M.D. , Eckhard Mayer M.D. , Erin McGuire PharmD, MBA , Nick H. Kim M.D.
Background
In a phase 2 study of inoperable chronic thromboembolic pulmonary hypertension (CTEPH), macitentan 10 mg improved hemodynamics and exercise capacity.
Methods
MACiTEPH (NCT04271475) was a prospective, double-blind, placebo-controlled, phase 3 study. Adult patients with inoperable CTEPH (with/without balloon pulmonary angioplasty [BPA]) or persistent/recurrent CTEPH after pulmonary endarterectomy (PEA) (with/without BPA) were randomized 1:1 to macitentan 75 mg or placebo once daily. Primary endpoint was change from baseline to Week 28 in 6-minute walk distance (6MWD).
Results
Following a pre-planned interim analysis, the study was stopped for futility. 127 patients were randomized, predominantly with inoperable CTEPH with BPA (36.2%) or persistent/recurrent CTEPH after PEA without BPA (30.7%). The majority (81.9%) were receiving pulmonary hypertension (PH)-specific therapy at baseline. 47 patients in the macitentan 75 mg and 48 in the placebo group had Week 28 assessments. Primary endpoint was not met; mean change in 6MWD from baseline to Week 28 versus placebo was −16.1 m (95% confidence limit: −32.3, 0.16). Clinical worsening events occurred in 6.3% and 14.3% of patients in the macitentan 75 mg and placebo groups, respectively. A slightly higher proportion of the macitentan 75 mg group had ≥1 adverse event (AE) or serious AE versus placebo; no pattern was identified. More patients in macitentan 75 mg versus placebo group discontinued treatment due to an AE (21.9% versus 7.9%, respectively).
Conclusions
MACiTEPH was discontinued for futility, as no treatment effect on 6MWD (primary endpoint) was observed. Despite the higher discontinuation rate in the macitentan 75 mg group, no unexpected safety signals were observed in CTEPH patients.
{"title":"Results of the MACiTEPH study of macitentan for the treatment of inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension","authors":"David P. Jenkins MB BS. , Sofija Cerovic M.D., MSc , Dénes Csonka PharmD, PhD , Hossein-Ardeschir Ghofrani M.D. , Stefan Guth M.D. , Gustavo A. Heresi M.D. , Marc Humbert M.D, PhD. , Noormaa Jaumdally MSc , Zhi-Cheng Jing M.D. , Gabriela Lack PhD, MSc Pharm , Michael M. Madani M.D., FACS , Hiromi Matsubara M.D. , Eckhard Mayer M.D. , Erin McGuire PharmD, MBA , Nick H. Kim M.D.","doi":"10.1016/j.healun.2025.11.014","DOIUrl":"10.1016/j.healun.2025.11.014","url":null,"abstract":"<div><h3>Background</h3><div>In a phase 2 study of inoperable chronic thromboembolic pulmonary hypertension (CTEPH), macitentan 10 mg improved hemodynamics and exercise capacity.</div></div><div><h3>Methods</h3><div>MACiTEPH (NCT04271475) was a prospective, double-blind, placebo-controlled, phase 3 study. Adult patients with inoperable CTEPH (with/without balloon pulmonary angioplasty [BPA]) or persistent/recurrent CTEPH after pulmonary endarterectomy (PEA) (with/without BPA) were randomized 1:1 to macitentan 75 mg or placebo once daily. Primary endpoint was change from baseline to Week 28 in 6-minute walk distance (6MWD).</div></div><div><h3>Results</h3><div>Following a pre-planned interim analysis, the study was stopped for futility. 127 patients were randomized, predominantly with inoperable CTEPH with BPA (36.2%) or persistent/recurrent CTEPH after PEA without BPA (30.7%). The majority (81.9%) were receiving pulmonary hypertension (PH)-specific therapy at baseline. 47 patients in the macitentan 75 mg and 48 in the placebo group had Week 28 assessments. Primary endpoint was not met; mean change in 6MWD from baseline to Week 28 versus placebo was −16.1 m (95% confidence limit: −32.3, 0.16). Clinical worsening events occurred in 6.3% and 14.3% of patients in the macitentan 75 mg and placebo groups, respectively. A slightly higher proportion of the macitentan 75 mg group had ≥1 adverse event (AE) or serious AE versus placebo; no pattern was identified. More patients in macitentan 75 mg versus placebo group discontinued treatment due to an AE (21.9% versus 7.9%, respectively).</div></div><div><h3>Conclusions</h3><div>MACiTEPH was discontinued for futility, as no treatment effect on 6MWD (primary endpoint) was observed. Despite the higher discontinuation rate in the macitentan 75 mg group, no unexpected safety signals were observed in CTEPH patients.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 442-451"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583802","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 : 2026-03-01Epub Date: 2025-11-24DOI: 10.1016/j.healun.2025.11.013
Jeff Teuteberg MD , Snehal Patel MD , David A. Baran MD , Palak Shah MD,MS , Gabriel Sayer MD , Ann B. Nguyen MD , Ashwin Ravichandran MD, MPH , Shelley Hall MD , Sean Pinney MD , Eugene DePasquale MD , Nirav Raval MD , Jeremy Kobulnik MD,MHSc , Chun-Po Steve Fan PhD, PStat , Kris Oreschak PhD , Sijia Wang MS , Kiran K. Khush MD, MAS , Nir Uriel MD
Background
Multimodal molecular testing with gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA) is increasingly used for rejection surveillance, but less is known about their joint ability to predict future clinical events.
Methods
We evaluated 1934 heart transplant recipients from the Surveillance HeartCare Outcomes Registry. Risk was assessed two ways. First, based on the most abnormal GEP/dd-cfDNA result during months 2–6 post-transplant, the incidence of graft dysfunction (GD) and cardiovascular (CV) death was assessed in the subsequent 12 months. Second, we analyzed the 30-day incidence of GD and CV death following individual GEP/dd-cfDNA results between 2-months and 5-years post-transplant.
Results
GD and CV death occurred in 166 and 19 patients during the 12-month follow-up period, respectively. In months 2 to 6 post-transplant, those with GEP+/dd-cfDNA+ had the highest incidence of GD or CV death (15.5%) in the following year, with a HR of 1.59 (1.08–2.32; p=0.017) versus those without GEP+/dd-cfDNA+. When limited to those without evidence of rejection in months 2 to 6, the GEP+/dd-cfDNA+ group had the highest incidence of GD or CV death (14.6% vs 5.1–8.7%; p=0.039). A single GEP+/dd-cfDNA+, versus a GEP-/dd-cfDNA- result, conferred a 3-fold increase in the 30-day incidence rate of GD or CV death (adjusted IRR 3.12; 95% CI 1.37–7.10; p=0.007).
Conclusions
Patients with dual positive GEP and dd-cfDNA are at increased risk for subsequent GD and CV death, even in the absence of histological evidence of rejection, indicating circulating multimodal molecular evidence of rejection provides prognostic information not detected by histology.
基因表达谱（GEP）和供体来源无细胞DNA （dd-cfDNA）的多模态分子检测越来越多地用于排斥反应监测，但对它们预测未来临床事件的联合能力知之甚少。方法：我们评估了来自心脏保健结局监测登记处的1934例心脏移植受者。风险评估有两种方式。首先，根据移植后2-6个月内最异常的GEP/dd-cfDNA结果，评估随后12个月内移植物功能障碍（GD）和心血管（CV）死亡的发生率。其次，我们分析了移植后2个月至5年个体GEP/dd-cfDNA结果后30天GD和CV死亡发生率。结果随访12个月，gd死亡166例，CV死亡19例。移植后2 ~ 6个月，GEP+/dd-cfDNA+组次年GD或CV死亡发生率最高（15.5%），与未GEP+/dd-cfDNA+组相比，HR为1.59 （1.08 ~ 2.32;p=0.017）。当局限于2 - 6个月无排斥反应证据的患者时，GEP+/dd-cfDNA+组的GD或CV死亡发生率最高（14.6% vs 5.1-8.7%; p=0.039）。单一的GEP+/dd-cfDNA+结果与GEP-/dd-cfDNA-结果相比，30天GD或CV死亡发生率增加3倍（校正IRR 3.12; 95% CI 1.37-7.10; p=0.007）。结论GEP和dd-cfDNA双重阳性的患者，即使在没有排斥反应的组织学证据的情况下，后续GD和CV死亡的风险也会增加，表明循环的多模态排斥反应分子证据提供了组织学未检测到的预后信息。
{"title":"Multimodal molecular testing provides prognostic value for heart transplant recipients","authors":"Jeff Teuteberg MD , Snehal Patel MD , David A. Baran MD , Palak Shah MD,MS , Gabriel Sayer MD , Ann B. Nguyen MD , Ashwin Ravichandran MD, MPH , Shelley Hall MD , Sean Pinney MD , Eugene DePasquale MD , Nirav Raval MD , Jeremy Kobulnik MD,MHSc , Chun-Po Steve Fan PhD, PStat , Kris Oreschak PhD , Sijia Wang MS , Kiran K. Khush MD, MAS , Nir Uriel MD","doi":"10.1016/j.healun.2025.11.013","DOIUrl":"10.1016/j.healun.2025.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Multimodal molecular testing with gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA) is increasingly used for rejection surveillance, but less is known about their joint ability to predict future clinical events.</div></div><div><h3>Methods</h3><div>We evaluated 1934 heart transplant recipients from the Surveillance HeartCare Outcomes Registry. Risk was assessed two ways. First, based on the most abnormal GEP/dd-cfDNA result during months 2–6 post-transplant, the incidence of graft dysfunction (GD) and cardiovascular (CV) death was assessed in the subsequent 12 months. Second, we analyzed the 30-day incidence of GD and CV death following individual GEP/dd-cfDNA results between 2-months and 5-years post-transplant.</div></div><div><h3>Results</h3><div>GD and CV death occurred in 166 and 19 patients during the 12-month follow-up period, respectively. In months 2 to 6 post-transplant, those with GEP+/dd-cfDNA+ had the highest incidence of GD or CV death (15.5%) in the following year, with a HR of 1.59 (1.08–2.32; p=0.017) versus those without GEP+/dd-cfDNA+. When limited to those without evidence of rejection in months 2 to 6, the GEP+/dd-cfDNA+ group had the highest incidence of GD or CV death (14.6% vs 5.1–8.7%; p=0.039). A single GEP+/dd-cfDNA+, versus a GEP-/dd-cfDNA- result, conferred a 3-fold increase in the 30-day incidence rate of GD or CV death (adjusted IRR 3.12; 95% CI 1.37–7.10; p=0.007).</div></div><div><h3>Conclusions</h3><div>Patients with dual positive GEP and dd-cfDNA are at increased risk for subsequent GD and CV death, even in the absence of histological evidence of rejection, indicating circulating multimodal molecular evidence of rejection provides prognostic information not detected by histology.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 388-400"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592839","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 : 2026-03-01Epub Date: 2026-02-14DOI: 10.1016/S1053-2498(26)00042-2
{"title":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(26)00042-2","DOIUrl":"10.1016/S1053-2498(26)00042-2","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Page A2"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146193189","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 : 2026-03-01Epub Date: 2025-11-24DOI: 10.1016/j.healun.2025.11.023
Megan Neely PhD , Emmanuel Mongodin PhD , Bryan A. Whitson MD, PhD , Ramsey R. Hachem MD , Michaela R. Anderson MD, MS , Courtney Frankel MS , Michelle L. Oyster MS , Ciara M. Shaver MD, PhD , Eric D. Morrell MD, MA , Meghan Aversa MD , Allyn M. Damman MA , Jason Christie MD, MSCE , Scott M. Palmer MD, MHS , on behalf of the Lung Transplant Consortium Investigators and Steering Committee
The Lung Transplant Consortium (LTC), sponsored by the National Heart, Lung, and Blood Institute (NHLBI) is a 20-center collaboration among lung transplant programs in North America conducting both smaller multicenter projects and one consortium-wide prospective observational cohort study called the Prospective Multicenter Research on Donor and Recipient Management Strategies to Improve Lung Transplant Outcomes (PROMISE) Lung Study—for more information about the LTC, visit their website: https://lungtransplantconsortium.org/. The LTC conducted a meeting in April 2025 to strategize how to maximize the benefits of the PROMISE study to advance the field of lung transplant. This paper summarizes the key themes that emerged from the meeting: leveraging PROMISE data elements, including biomarkers, imaging, and PROs; clinical syndrome and consensus definitions; variation in management and management strategies; and future interventional trials leveraging the PROMISE consortium. The PROMISE study will serve as the platform for establishing best practices in lung transplant, inform the validity of newly identified syndromes, and support analysis of patient-reported outcomes, image data, and biosamples. The PROMISE study and LTC create a critically needed research platform and multicenter collaborative structure that may be adapted to conduct future multicenter clinical trials that will advance lung transplant medicine.
{"title":"The NHLBI lung transplant consortium 2025 steering committee report: Strategies to maximize the use of the consortium for advancing lung transplantation","authors":"Megan Neely PhD , Emmanuel Mongodin PhD , Bryan A. Whitson MD, PhD , Ramsey R. Hachem MD , Michaela R. Anderson MD, MS , Courtney Frankel MS , Michelle L. Oyster MS , Ciara M. Shaver MD, PhD , Eric D. Morrell MD, MA , Meghan Aversa MD , Allyn M. Damman MA , Jason Christie MD, MSCE , Scott M. Palmer MD, MHS , on behalf of the Lung Transplant Consortium Investigators and Steering Committee","doi":"10.1016/j.healun.2025.11.023","DOIUrl":"10.1016/j.healun.2025.11.023","url":null,"abstract":"<div><div>The Lung Transplant Consortium (LTC), sponsored by the National Heart, Lung, and Blood Institute (NHLBI) is a 20-center collaboration among lung transplant programs in North America conducting both smaller multicenter projects and one consortium-wide prospective observational cohort study called the Prospective Multicenter Research on Donor and Recipient Management Strategies to Improve Lung Transplant Outcomes (PROMISE) Lung Study—for more information about the LTC, visit their website: <span><span>https://lungtransplantconsortium.org/</span><svg><path></path></svg></span>. The LTC conducted a meeting in April 2025 to strategize how to maximize the benefits of the PROMISE study to advance the field of lung transplant. This paper summarizes the key themes that emerged from the meeting: leveraging PROMISE data elements, including biomarkers, imaging, and PROs; clinical syndrome and consensus definitions; variation in management and management strategies; and future interventional trials leveraging the PROMISE consortium. The PROMISE study will serve as the platform for establishing best practices in lung transplant, inform the validity of newly identified syndromes, and support analysis of patient-reported outcomes, image data, and biosamples. The PROMISE study and LTC create a critically needed research platform and multicenter collaborative structure that may be adapted to conduct future multicenter clinical trials that will advance lung transplant medicine.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 317-323"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592836","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 : 2026-03-01Epub Date: 2025-11-28DOI: 10.1016/j.healun.2025.11.031
Hakim Ghani , Joanna Pepke-Zaba
{"title":"Old clots, new questions — the anticoagulation saga continues in chronic thromboembolic pulmonary hypertension","authors":"Hakim Ghani , Joanna Pepke-Zaba","doi":"10.1016/j.healun.2025.11.031","DOIUrl":"10.1016/j.healun.2025.11.031","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 457-459"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611719","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 : 2026-03-01Epub Date: 2025-11-21DOI: 10.1016/j.healun.2025.11.012
Lorraine B. Ware MD , Tatsuki Koyama PhD , Ciara M. Shaver MD, PhD , Michael A. Matthay MD
{"title":"Reply to “Lung protective ventilation in organ donors: Moving toward precision and contextualized strategies”","authors":"Lorraine B. Ware MD , Tatsuki Koyama PhD , Ciara M. Shaver MD, PhD , Michael A. Matthay MD","doi":"10.1016/j.healun.2025.11.012","DOIUrl":"10.1016/j.healun.2025.11.012","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 524-525"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145567312","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 : 2026-03-01Epub Date: 2025-10-07DOI: 10.1016/j.healun.2025.09.020
Nicholas J.S. Chilvers MB, BChir, MA, MRCS , Katrien Vandendriessche MD , Niels Moeslund MD, PhD , Marius Berman MD FRCS(CTh) , Janne Brouckaert MD , Tanveer Butt FRCS , Barbara Cardoso MD , Bjorn Cools MD, PhD , David Crossland MB, ChB, MRCPCH , John Dark MBBS, FRCS, FRCP , Paul Henderson , Katherine Hulley , Mylvaganam Jeyakanthan MBChB, PhD, FRCS(CTh) , Jerome Jungschleger BSc, MSc, MD , Pradeep Kaul MBBS, FRCS(CTh) , Muhammad Khawaja MBBS, FRCS(CTh) , Klaes V. Lenbroch , Alan McCheyne BSc, MB ChB, FRCA , Mohamed Nassar MD, FRCS(CTh) , Filip Rega MD, PhD , Louise Kenny MBBS, MSC(ED), FRCS(CTh)
Background
The number of children referred for advanced heart failure management is increasing and with it the demand for heart transplant. However, transplantation rates have declined and waiting list mortality is up to 25%. While donation after circulatory death (DCD) heart recovery has increased adult transplant activity significantly, barriers have prevented the same in pediatrics. In the UK and Belgium, we have adopted hypothermic oxygenated perfusion (HOPE) to address this inequity.
Methods
Preclinical: A porcine DCD-HOPE model was developed to simulate neonatal and infant heart recovery, preservation, and transplantation, including functional assessment. Clinical: Hearts were recovered from 6 pediatric donors (3 DCD and 3 donation after brainstem death), aged 16 months-13 years), preserved with HOPE and transplanted. For small donors, this required a pediatric research cannula and surgical techniques, such as arch augmentation.
Results
In the preclinical model, porcine infant hearts could be successfully recovered, perfused, and transplanted with good cardiac output postbypass. In the clinical series, hearts from donors as small as 9 kg were successfully recovered, perfused, and transplanted. For the DCD cohort, median functional warm ischemic time was 19 minutes and there was no severe primary graft dysfunction. Survival at follow-up (median 287.5 days) was 100% and echocardiograms showed normal systolic function.
Conclusions
There is great need to facilitate DCD heart recovery for infants and neonates. We have reported our outcomes from the world’s first and smallest pediatric DCD-HOPE heart transplants and demonstrated that HOPE provides the long-awaited solution for pediatric DCD donation down to even neonatal donors. We call upon clinicians and policymakers to support DCD-HOPE to provide equity for child donors and recipients.
{"title":"HOPE for children: successful pediatric DCD heart transplantation using hypothermic oxygenated perfusion","authors":"Nicholas J.S. Chilvers MB, BChir, MA, MRCS , Katrien Vandendriessche MD , Niels Moeslund MD, PhD , Marius Berman MD FRCS(CTh) , Janne Brouckaert MD , Tanveer Butt FRCS , Barbara Cardoso MD , Bjorn Cools MD, PhD , David Crossland MB, ChB, MRCPCH , John Dark MBBS, FRCS, FRCP , Paul Henderson , Katherine Hulley , Mylvaganam Jeyakanthan MBChB, PhD, FRCS(CTh) , Jerome Jungschleger BSc, MSc, MD , Pradeep Kaul MBBS, FRCS(CTh) , Muhammad Khawaja MBBS, FRCS(CTh) , Klaes V. Lenbroch , Alan McCheyne BSc, MB ChB, FRCA , Mohamed Nassar MD, FRCS(CTh) , Filip Rega MD, PhD , Louise Kenny MBBS, MSC(ED), FRCS(CTh)","doi":"10.1016/j.healun.2025.09.020","DOIUrl":"10.1016/j.healun.2025.09.020","url":null,"abstract":"<div><h3>Background</h3><div>The number of children referred for advanced heart failure management is increasing and with it the demand for heart transplant. However, transplantation rates have declined and waiting list mortality is up to 25%. While donation after circulatory death (DCD) heart recovery has increased adult transplant activity significantly, barriers have prevented the same in pediatrics. In the UK and Belgium, we have adopted hypothermic oxygenated perfusion (HOPE) to address this inequity.</div></div><div><h3>Methods</h3><div>Preclinical: A porcine DCD-HOPE model was developed to simulate neonatal and infant heart recovery, preservation, and transplantation, including functional assessment. Clinical: Hearts were recovered from 6 pediatric donors (3 DCD and 3 donation after brainstem death), aged 16 months-13 years), preserved with HOPE and transplanted. For small donors, this required a pediatric research cannula and surgical techniques, such as arch augmentation.</div></div><div><h3>Results</h3><div>In the preclinical model, porcine infant hearts could be successfully recovered, perfused, and transplanted with good cardiac output postbypass. In the clinical series, hearts from donors as small as 9 kg were successfully recovered, perfused, and transplanted. For the DCD cohort, median functional warm ischemic time was 19 minutes and there was no severe primary graft dysfunction. Survival at follow-up (median 287.5 days) was 100% and echocardiograms showed normal systolic function.</div></div><div><h3>Conclusions</h3><div>There is great need to facilitate DCD heart recovery for infants and neonates. We have reported our outcomes from the world’s first and smallest pediatric DCD-HOPE heart transplants and demonstrated that HOPE provides the long-awaited solution for pediatric DCD donation down to even neonatal donors. We call upon clinicians and policymakers to support DCD-HOPE to provide equity for child donors and recipients.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 494-512"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246495","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 : 2026-03-01Epub Date: 2025-11-13DOI: 10.1016/j.healun.2025.10.021
Jiho Han MD , Mikail Siddiki MD , Sara Kalantari MD , Mark N. Belkin MD , Jonathan Grinstein MD
Background
The purpose of the study is to assess a novel hemodynamic parameter, right ventricular myocardial performance score (RV-MPS), as a marker for right ventricular function and prognosis for advanced heart failure patients.
Methods
A total of 800 pressure-volume loop in silico simulations were performed at various hemodynamic conditions. RV-MPS was calculated as (3 × pulmonary artery pulsatility index [PAPI] × right ventricular cardiac power output [RV-CPO]) / 2. For the validation cohort, a total of 223 patients with advanced heart failure who underwent invasive hemodynamic testing from January 2013 to December 2019 were included. Advanced hemodynamic parameters, including RV-CPO, PAPI, and RV-MPS were calculated.
Results
In the simulation cohort, the median RV-CPO was (median 0.22, IQR: [0.08, 0.33] watts), RV coupling ratio was (median 1.3, IQR: [0.87, 1.85], and PAPI (median 2.2, IQR: [1.2, 3.5]), and the median RV-MPS was 0.74 (IQR: 0.19, 1.60). Simulations showed increases in RV EES and RV mechanical efficiency was associated with increase in RV-MPS for all conditions of stressed blood volume and arterial resistance. In the validation cohort, RV-MPS (OR: 0.64, 95% CI: [0.43, 0.97], p = 0.037), baseline creatinine (OR: 0.71, 95% CI: [0.51, 0.97], p = 0.32), and PCWP (OR: 1.05, 95% CI: [1.01, 1.10], p = 0.011) were independent predictors of composite outcome of death and need for heart replacement therapy at 1-year. Prior to left ventricular assist device implantation (n = 33), patients with RV-MPS <0.5 had significantly increased incidence of RV failure compared to patients with preserved RV-MPS ≥0.5 (66.7% vs. 16.7%, p = 0.003).
Conclusions
RV-MPS is a reliable estimator of RV function on in silico simulations. RV-MPS was an independent predictor of death or need for heart replacement therapy and may have a role in prognostication of advanced heart failure patients.
{"title":"Advanced hemodynamics for right ventricular failure: Evaluating the use of the myocardial performance score","authors":"Jiho Han MD , Mikail Siddiki MD , Sara Kalantari MD , Mark N. Belkin MD , Jonathan Grinstein MD","doi":"10.1016/j.healun.2025.10.021","DOIUrl":"10.1016/j.healun.2025.10.021","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of the study is to assess a novel hemodynamic parameter, right ventricular myocardial performance score (RV-MPS), as a marker for right ventricular function and prognosis for advanced heart failure patients.</div></div><div><h3>Methods</h3><div>A total of 800 pressure-volume loop <em>in silico</em> simulations were performed at various hemodynamic conditions. RV-MPS was calculated as (3 × pulmonary artery pulsatility index [PAPI] × right ventricular cardiac power output [RV-CPO]) / 2. For the validation cohort, a total of 223 patients with advanced heart failure who underwent invasive hemodynamic testing from January 2013 to December 2019 were included. Advanced hemodynamic parameters, including RV-CPO, PAPI, and RV-MPS were calculated.</div></div><div><h3>Results</h3><div>In the simulation cohort, the median RV-CPO was (median 0.22, IQR: [0.08, 0.33] watts), RV coupling ratio was (median 1.3, IQR: [0.87, 1.85], and PAPI (median 2.2, IQR: [1.2, 3.5]), and the median RV-MPS was 0.74 (IQR: 0.19, 1.60). Simulations showed increases in RV E<sub>ES</sub> and RV mechanical efficiency was associated with increase in RV-MPS for all conditions of stressed blood volume and arterial resistance. In the validation cohort, RV-MPS (OR: 0.64, 95% CI: [0.43, 0.97], <em>p</em> = 0.037), baseline creatinine (OR: 0.71, 95% CI: [0.51, 0.97], <em>p</em> = 0.32), and PCWP (OR: 1.05, 95% CI: [1.01, 1.10], <em>p</em> = 0.011) were independent predictors of composite outcome of death and need for heart replacement therapy at 1-year. Prior to left ventricular assist device implantation (n = 33), patients with RV-MPS <0.5 had significantly increased incidence of RV failure compared to patients with preserved RV-MPS ≥0.5 (66.7% vs. 16.7%, <em>p</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>RV-MPS is a reliable estimator of RV function on <em>in silico</em> simulations. RV-MPS was an independent predictor of death or need for heart replacement therapy and may have a role in prognostication of advanced heart failure patients.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 378-385"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525115","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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