Journal of Heart and Lung Transplantation最新文献_第4页

Severe early graft dysfunction post-heart transplantation: Two clinical trajectories and diastolic perfusion pressure as a predictor of mechanical circulatory support 心脏移植术后严重的早期移植物功能障碍：两种临床轨迹和作为机械循环支持预测因子的舒张灌注压。

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.09.002

Hoong Sern Lim MD , Sai Bhagra MRCP , Marius Berman FRCS , Chun Shing Kwok PhD , Colin Chue PhD , Aaron Ranasinghe MD , Stephen Pettit PhD

Background

Severe early graft dysfunction (EGD) is defined by mechanical circulatory support (MCS) <24 hours of heart transplantation (HT). We classified severe EGD based on timing of post-HT MCS: ‘‘Immediate’’ intra-operative vs ‘‘Delayed’’ post-operative MCS (after admission into intensive care unit (ICU) from operating theater). We hypothesized that (1) risk factors and clinical course differ between ‘‘Immediate’’ and ‘‘Delayed’’ MCS; and (2) diastolic perfusion pressure (DPP = diastolic blood pressure-central venous pressure) and Norepinephrine equivalents (NE = sum of vasopressor doses), as measures of vasoplegia are related to ‘‘Delayed’’ MCS.

Methods

Two-center study of 216 consecutive patients who underwent HT. Recipient, donor, vasopressor doses and hemodynamic data at T0 and T6 (on admission and 6 hours after admission into ICU) were collected.

Results

Of the 216 patients, 67 patients had severe EGD (‘‘Immediate’’ MCS: n = 43, ‘‘Delayed’’ MCS: n = 24). The likelihood of ‘‘immediate’’ MCS but not ‘‘delayed’’ MCS increased with increasing warm ischemic and cardiopulmonary bypass times on multinomial regression analysis with ‘‘no MCS’’ as the referent group. One-year mortality was highest in ‘‘Immediate’’ MCS vs ‘‘no MCS’’ and ‘‘delayed’’ MCS (34.9% vs 3.4% and 8% respectively, p < 0.001). Of the patients who had no immediate post-transplant MCS, DPP and NE at T6 were independently associated with subsequent ‘‘delayed’’ MCS. Sensitivity and specificity of NE ≥ 0.2 mcg/kg/min for ‘‘Delayed’’ MCS were 71% and 81%. Sensitivity and specificity of DPP of ≥40 mm Hg for No MCS were 83% and 74%. The discriminatory value of systemic vascular resistance for ‘‘Delayed’’ MCS was poor.

Conclusion

Risk factors and 1-year survival differed significantly between ‘‘Immediate’’ and ‘‘Delayed’’ post-HT MCS. The latter is related to lower DPP and higher NE, which is consistent with vasoplegia as the dominant pathophysiology.

背景严重的早期移植物功能障碍（EGD）是指心脏移植（HT）后机械循环支持（MCS）时间小于24小时。我们根据心脏移植术后机械循环支持的时间对严重移植物功能障碍进行了分类：术中 "即时 "机械循环支持与术后 "延迟 "机械循环支持（从手术室进入重症监护室（ICU）后）。我们的假设是：(i) "即刻 "和 "延迟 "MCS 的风险因素和临床过程不同；(ii) 舒张灌注压（DPP=舒张压-中心静脉压）和去甲肾上腺素当量（NE=血管舒张剂剂量总和）作为血管痉挛的测量指标与 "延迟 "MCS 有关。结果在 216 例患者中，67 例患者有严重的 EGD（"即刻 "MCS：43 例，"延迟 "MCS：24 例）。在多项式回归分析中，以 "无 MCS "为参照组，"即刻 "MCS 而非 "延迟 "MCS 的可能性随着暖缺血时间和心肺旁路时间的增加而增加。与 "无 MCS "和 "延迟 "MCS 相比，"立即 "MCS 的一年死亡率最高（分别为 34.9% vs 3.4% 和 8%，P<0.001）。在移植后未立即发生 MCS 的患者中，T6 时的 DPP 和 NE 与随后发生的 "延迟 "MCS 独立相关。NE≥0.2mcg/kg/min对 "延迟 "MCS的敏感性和特异性分别为71%和81%。DPP≥40mmHg 对无 MCS 的敏感性和特异性分别为 83% 和 74%。结论 "即刻 "和 "延迟 "HT 后 MCS 的风险因素和一年生存率存在显著差异。后者与较低的 DPP 和较高的 NE 有关，这与血管痉挛是主要病理生理学相一致。

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引用次数: 0

Early stroke following durable left ventricular assist device (LVAD) implantation: An analysis of the Society of Thoracic Surgeons Intermacs National Database 持久性左心室辅助装置 (LVAD) 植入术后的早期中风：胸外科医师学会 Intermacs 国家数据库分析。

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.09.031

Ezequiel J. Molina , Daniel Goldstein , Ryan S. Cantor , Manreet K. Kanwar , Dan Meyer , Ulrich Jorde , Omar Saeed , Katherine Wood , Rama Raju Rudraraju , Seth Lewis , James K. Kirklin , Francis D. Pagani , Arman Kilic MD

Background

Stroke remains a devastating complication of durable left ventricular assist device (LVAD) therapy. This study evaluated the incidence and risk factors for early stroke within 7 days following LVAD implantation investigating both traditional pre-implant and new intraoperative variables collected by The Society of Thoracic Surgeons (STS) Intermacs National Database.

Methods

STS Intermacs was queried for patients undergoing implantation of a fully magnetically levitated centrifugal LVAD between November 25, 2020 and June 30, 2023. STS Intermacs stroke definitions were used to identify patients who suffered a stroke within the first 7 postoperative days (POD). A multivariable logistic regression model was created to generate adjusted odd ratios (OR) for variables associated with early stroke.

Results

Among 6,950 patients in the study cohort, 5.9% (413/6950) developed a stroke after a median follow-up of 11 months, with 50% (205/413) of strokes occurring within 7 days after LVAD implantation. Of the strokes occurring during POD 0-7, 70% (144/205) occurred on POD 0-2. By multivariable analysis, the following factors were associated with early stroke: older age (70 vs 50; OR 1.4, p = 0.0129), white race (OR 1.5, p = 0.0078), pre-implant temporary mechanical circulatory support (MCS) bridge (temporary LVAD only: OR 1.6, extracorporeal membrane oxygenation [ECMO] only: OR 1.7, combination of both devices: OR 3.3; p = 0.0001) and presence of an unremoved left atrial clot (OR 8.0, p < 0.0001).

Conclusions

A significant proportion of strokes occur within the first 7 days following LVAD implantation, particularly within the first 2 days. In addition to pre-implant variables, we identified modifiable intraoperative factors associated with stroke that provide an opportunity for further risk mitigation and improvement in quality of care.

背景：中风仍然是左心室辅助装置（LVAD）持久治疗的一种破坏性并发症。本研究通过胸外科医师学会（STS）Intermacs 国家数据库收集的传统植入前变量和新的术中变量，评估了 LVAD 植入术后 7 天内早期中风的发生率和风险因素：对 2020 年 11 月 25 日至 2023 年 6 月 30 日期间接受全磁悬浮离心式 LVAD 植入术的患者进行了 STS Intermacs 查询。STS Intermacs 中风定义用于识别术后前 7 天 (POD) 内发生中风的患者。建立了一个多变量逻辑回归模型，以生成与早期中风相关变量的调整奇数比 (OR)：结果：在研究队列的 6950 名患者中，5.9%（413/6950）的患者在中位随访 11 个月后发生中风，其中 50%（205/413）的中风发生在 LVAD 植入术后 7 天内。在 POD 0-7 期间发生的中风中，70%（144/205）发生在 POD 0-2。通过多变量分析，以下因素与早期中风相关：年龄较大（70 岁对 50 岁；OR 1.4，P=0.0129）、白种人（OR 1.5，P=0.0078）、植入前临时 MCS 桥接（仅临时 LVAD：OR 1.6，仅 ECMO：OR 1.7，两者结合：OR 1.7：OR1.7，两种装置的组合：OR3.3；P=0.0001）以及存在未移除的左心房血栓（OR8.0，PC结论：很大一部分中风发生在植入 LVAD 后的头 7 天内，尤其是头 2 天内。除了植入前的变量外，我们还发现了与中风相关的术中可改变因素，这些因素为进一步降低风险和提高护理质量提供了机会。

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引用次数: 0

Could emulated trials play a key role in cardiogenic shock trials? 模拟试验能否在心源性休克试验中发挥关键作用？

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.10.025

Aurore Ughetto MD, MSc , Nicolas Nagot MD, PhD , Clément Delmas MD, PhD

Temporary mechanical circulatory support (tMCS) using extracorporeal life support (ECLS), has been widely implemented in patients with cardiogenic shock (CS), although evidence regarding its efficacy and safety remains unclear. This lack of clarity has recently raised concerns about the role of tMCS in CS management. Conducting randomized controlled trials (RCTs) in the context of CS poses significant challenges due to ethical considerations and logistical complexities. In response to these challenges, emulated trials (ETs) are emerging as a promising alternative. By incorporating design features from idealized RCTs, they use robust and rigorous methods to assess the efficacy and safety of health interventions in real-life settings, using observational data. In our manuscript, we highlight the complementary nature of RCT and ETs by evaluating tMCS for CS patients. While RCTs follow a rigorous experimental design and provide reliable evidence, ETs can swiftly estimate the risk-benefit ratio without encountering logistical barriers thereby offering clinicians’ early reassurance about the potential benefits of routinely used interventions. Furthermore, ETs offer potential value in unethical situations (refractory cardiac arrest or "crash and burn" CS) where interventional therapies, such as tMCS, are used as a last resort.

使用体外生命支持（ECLS）的临时机械循环支持（tMCS）已在心源性休克（CS）患者中广泛使用，但有关其疗效和安全性的证据仍不明确。这种不明确性最近引起了人们对 tMCS 在 CS 治疗中的作用的关注。由于伦理方面的考虑和后勤方面的复杂性，在 CS 中开展随机对照试验（RCT）面临着巨大的挑战。为了应对这些挑战，模拟试验（ETs）作为一种有前途的替代方法正在兴起。模拟实验结合了理想化 RCT 的设计特点，采用稳健、严格的方法，利用观察数据评估现实生活环境中健康干预措施的有效性和安全性。在我们的手稿中，我们通过评估针对 CS 患者的 tMCS，强调了 RCT 和 ET 的互补性。RCT 遵循严格的实验设计并能提供可靠的证据，而 ET 则能在不遇到后勤障碍的情况下迅速估算出风险收益比，从而为临床医生提供关于常规干预措施潜在益处的早期保证。此外，ET 还能在不符合伦理道德的情况下（难治性心脏骤停或 "崩溃和烧毁 "CS）提供潜在价值，在这种情况下，介入疗法（如 tMCS）是作为最后手段使用的。

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引用次数: 0

Sympathetic reinnervation in cardiac transplant recipients: Prevalence, time course, and association with long-term survival 心脏移植受者的交感神经再支配：发病率、时间过程以及与长期存活的关系。

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.10.009

Oliver J.F. Weiner , Moloy Das , Richard H. Clayton , Janet M. McComb , Alan Murray , Gareth Parry , Stephen W. Lord

Background

Partial cardiac sympathetic reinnervation after cardiac transplant has been extensively investigated and evidenced. However, there have been no large-scale, long-term studies evaluating the prevalence, time-course, and association with long-term survival of sympathetic reinnervation of the heart.

Methods

Cardiac transplant recipients (n = 232) were recruited from outpatient clinic at a single transplant center in the United Kingdom. Participants were each tested once for the presence of sympathetic reinnervation of the sinus node using the low-frequency component of power spectral analysis of heart rate variability, with a cutoff defined as 2 standard deviations above the mean for denervated participants (those tested <56 days posttransplant). Time course was calculated based on the timing of testing posttransplant. Patients were then followed up over a period of up to 27 years after transplant for survival analysis.

Results

The overall prevalence of cardiac sympathetic reinnervation in the 225 patients tested >56 days posttransplant was 64.9%. Sympathetic reinnervation primarily occurred in the first 18 months after transplant, with a plateau thereafter. The prevalence in participants tested >18 months posttransplant was 69.6%. In Kaplan-Meier survival analysis, sympathetic reinnervation was associated with significantly improved survival (Log-rank p = 0.019), with a median survival time for reinnervated patients of 19.9 years compared with 14.4 years for the denervated group.

Conclusions

Sympathetic reinnervation of the sinus node occurs mostly within 18 months of transplant, is found in 70% of cardiac transplant recipients tested >18 months posttransplant, and is associated with significantly improved long-term survival.

背景：心脏移植后部分心脏交感神经再支配已得到广泛研究和证实。然而，目前还没有大规模的长期研究对心脏交感神经再支配的发生率、时间进程以及与长期存活的关系进行评估：方法：从英国一家移植中心的门诊招募心脏移植受者（232 人）。利用心率变异性功率谱分析的低频分量对每位受试者进行一次窦房结交感神经再支配的检测，对去神经支配的受试者（检测结果）的临界值定义为高于平均值 2 个标准差：在移植后 56 天以上接受测试的 225 名患者中，心脏交感神经再支配的总体发生率为 64.9%。交感神经再支配主要发生在移植后的前 18 个月，此后趋于稳定。接受移植后 18 个月以上检测的患者中，交感神经再支配的发生率为 69.6%。在卡普兰-梅耶生存分析中，交感神经再支配与生存率的显著提高有关（Log-rank P=0.019），再支配患者的中位生存时间为19.9年，而去神经支配组为14.4年：结论：窦房结的交感神经再支配大多发生在移植后 18 个月内，70% 的心脏移植受者在移植后 18 个月内接受了检测，并且与长期存活率的显著提高有关。

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引用次数: 0

Lung transplant pathology: No longer through a glass darkly? 肺移植病理学：不再 "隔岸观火"？

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.10.017

Allan R. Glanville MBBS, FRACP, MD

引用次数: 0

Diagnostic alignment to optimize inter-rater reliability among lung transplant pathologists 肺移植病理学家之间的诊断调整以优化评分者之间的可靠性。

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.10.007

Elizabeth N. Pavlisko MD , Megan L. Neely PhD , Kathryn A. Wikenheiser-Brokamp MD, PhD , Gregory A. Fishbein MD , Leslie Litzky MD , Carol F. Farver MD , Prodipto Pal MD, PhD , Mai He MD , Peter B. Illei MD , Charuhas Deshpande MD , Mark A. Robien MD , Jerry Kirchner BS , Courtney W. Frankel PT, MS , Jason E. Lang MD, MPH , John A. Belperio MD , Scott M. Palmer MD, MPH , Stuart C. Sweet MD, PhD , On behalf of the Clinical Trials and Organ Transplantation (CTOT)-47 consortium

Background

Poor agreement among lung transplant (LTx) pathologists has been reported in the assessment of rejection. In addition to acute rejection (AR) and lymphocytic bronchiolitis (LB), acute lung injury (ALI) and organizing pneumonia (OP) were recently identified as histopathologic risk factors for chronic lung allograft dysfunction (CLAD). Therefore, maximizing inter-rater reliability (IRR) for identifying these histopathologic risk factors is important to guide individual patient care and to support incorporating them in inclusion criteria for clinical trials in lung transplantation.

Methods

Nine pathologists across 8 North American LTx centers were surveyed for practices in the assessment of LTx transbronchial biopsies. We conducted 7 diagnostic alignment sessions with pathologists discussing histomorphologic features of CLAD high-risk histopathology. Then, each pathologist blindly scored 75 digitized slides. Fleiss’ kappa, accounting for agreement across numerous observers, was used to determine IRR across all raters for the presence of any high-risk finding and each individual entity.

Results

IRR (95% confidence intervals) and % agreement for any high-risk finding (AR, LB, ALI, and/or OP) and each individual finding is as follows: Any Finding, k = 0.578 (0.487, 0.668), 78.9%; AR, k = 0.582 (0.481, 0.651), 79.1%; LB, k = 0.683 (0.585, 0.764), 83.5%; ALI, k = 0.418 (0.312, 0.494), 70.9%; and OP, k = 0.621 (0.560, 0.714), 81.0%.

Conclusions

After prestudy diagnostic alignment sessions, a multicenter group of LTx pathologists seeking to identify histopathology high-risk for CLAD achieved good IRR.

背景据报道，肺移植病理学家在评估排斥反应时意见不统一。除了急性排斥反应（AR）和淋巴细胞性支气管炎（LB）外，急性肺损伤（ALI）和组织性肺炎（OP）最近也被确定为慢性肺移植功能障碍（CLAD）的组织病理学风险因素。因此，最大限度地提高鉴定这些组织病理学风险因素的评分者间可靠性（IRR）对于指导患者的个体治疗和支持将其纳入肺移植临床试验的纳入标准非常重要。方法我们对北美八个肺移植中心的九位病理学家进行了调查，了解他们在评估肺移植经支气管活检组织病理学方面的做法。我们与病理学家进行了七次诊断对齐会议，讨论 CLAD 高风险组织病理学的组织形态学特征。然后，每位病理学家对 75 张数字化切片进行盲法评分。结果任何高风险发现（AR、LB、ALI和/或OP）和每个单独发现的IRR（95%置信区间）和一致性百分比如下：任何发现，k = 0.578 (0.487, 0.668)，78.9%；AR，k = 0.582 (0.481, 0.651)，79.1%；LB，k = 0.683 (0.585, 0.764)，83.5%；ALI，k = 0.418 (0.312, 0.494)，70.9%；OP，k = 0.621 (0.560, 0.714)，81.0%。0%.结论经过研究前的诊断对齐会议，一组多中心肺移植病理学家在寻求识别 CLAD 高风险组织病理学时取得了良好的 IRR。

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引用次数: 0

Loss of right ventricular outflow function in pulmonary hypertension 肺动脉高压患者右心室流出功能丧失

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.09.026

Bruno R. Brito da Rocha , Athiththan Yogeswaran MD , Bálint K. Lakatos MD , Alexandra Fábián MD , Henning Gall MD, PhD , Hossein A. Ghofrani MD , Nils C. Kremer MD , Simon Schäfer , Werner Seeger MD , Daniel Zedler , Selin Yildiz , Zvonimir A. Rako MD , Attila Kovács MD, PhD , Khodr Tello MD

Right ventricular outflow tract (RVOT) function is not systematically quantified by three-dimensional (3D) echocardiography. We tested the hypothesis that loss of RVOT function in pulmonary hypertension (PH) is related to disease severity independently of other echocardiographic parameters. In this observational study, patients with PH, disease controls, and a matched healthy control group underwent 3D echocardiography and RVOT analysis using ReVISION software. The study included 43 patients (38 with PH, 5 disease controls) and 43 healthy controls. Median 3D RVOT-ejection fraction (EF) was 30.4% in the patients and 44.2% in the healthy controls (p < 0.001). Patients with low 3D RVOT-EF (<30.4%) were more frequently categorized in higher-risk groups and had a higher incidence of clinical worsening than those with high 3D RVOT-EF. Even in patients with RV-EF ≥35%, those with low 3D RVOT-EF had worse outcomes. Segmental RVOT analysis identifies high-risk patients even with normal overall RV function.

右心室流出道（RVOT）功能并未通过三维（3D）超声心动图进行系统量化。我们测试了肺动脉高压（PH）患者 RVOT 功能丧失与疾病严重程度相关的假设，而与其他超声心动图参数无关。在这项观察性研究中，PH 患者、疾病对照组和匹配的健康对照组接受了三维超声心动图检查，并使用 ReVISION 软件进行了 RVOT 分析。研究包括 43 名患者（38 名 PH 患者，5 名疾病对照组）和 43 名健康对照组。患者的中位三维 RVOT 射血分数（EF）为 30.4%，健康对照组为 44.2%（P < 0.001）。三维 RVOT 射血分数（EF）较低的患者（P<0.001

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引用次数: 0

The lung transplant endobronchial biopsy: A forgotten specimen comes of age 肺移植支气管内活检：一个被遗忘的标本迎来了新时代。

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.10.019

Kieran Halloran MD, MSc , Robin Vos MD, PhD , Greg Snell MD , John R. Greenland MD, PhD

Mucosal or endobronchial biopsies (EBB) are typically used in the diagnosis of directly visualized bronchial lesions, infection, and sarcoidosis, but their utility in the evaluation of lung transplant recipients is controversial. EBB represents an attractive alternative to transbronchial biopsy (TBB): EBB provides straightforward sampling of airway pathology with decreased complication rates due to minimal and visualizable bleeding and the elimination of pneumothorax risk. In lung transplant recipients, EBB may be obtained when TBB is too high-risk, including in the setting of acute lung allograft dysfunction (ALAD) requiring mechanical ventilation or in advanced chronic lung allograft dysfunction (CLAD). Most centers do not include EBB in post-transplant surveillance or for-cause bronchoscopy protocols, possibly due to a lack of a common histologic interpretation system. Previous work has demonstrated that lymphocytic inflammation in lung transplant EBB is associated with acute cellular rejection and future risk for CLAD, but these have not translated into subsequent studies on clinical utility or into clinical practice. Recent multicenter studies suggest that gene expression-based diagnostics leveraging EBB may outperform histologic grading and provide important prognostic utility in predicting graft loss. Herein, we will review what is known about the lung transplant mucosa including recent diagnostic advances and propose how EBB analyses could be incorporated into research studies and clinical workflows. We propose that mucosal sampling could provide safe, consistent, and informative data to improve patient outcomes after lung transplant.

粘膜或支气管内活检（EBB）通常用于诊断可直接观察到的支气管病变、感染和肉样瘤病，但其在肺移植受者评估中的实用性还存在争议。经支气管活检（TBB）是一种极具吸引力的替代方法：EBB 可直接采集气道病理样本，由于出血量少且可视，并消除了气胸风险，从而降低了并发症发生率。在肺移植受者中，当TBB风险过高时，包括需要机械通气的急性肺移植功能障碍（ALAD）或晚期慢性肺移植功能障碍（CLAD）时，可进行EBB。可能由于缺乏通用的组织学解释系统，大多数中心没有将 EBB 纳入移植后监测或因病支气管镜检查方案中。以前的研究表明，肺移植 EBB 中的淋巴细胞炎症与急性细胞排斥反应和未来的 CLAD 风险有关，但这些研究并未转化为后续的临床实用性研究或临床实践。最近的多中心研究表明，基于基因表达的EBB诊断可能优于组织学分级，并在预测移植物损失方面提供重要的预后效用。在此，我们将回顾对肺移植粘膜的了解，包括最近的诊断进展，并提出如何将 EBB 分析纳入研究和临床工作流程。我们建议，粘膜取样可提供安全、一致且信息丰富的数据，以改善肺移植后患者的预后。

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引用次数: 0

Nr4a1: A multilevel target to overcome PGD in lung transplantation Nr4a1：克服肺移植中 PGD 的多层次靶点。

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.11.008

Cedric Vanluyten MD , Robin Vos MD, PhD , Laurens J. Ceulemans MD, PhD

引用次数: 0

A perspective on the added value of red blood cells during cardiac hypothermic oxygenated perfusion 透视心脏低温氧合灌注过程中红血细胞的附加值。

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.healun.2024.09.025

Mats T. Vervoorn MD , Elisa M. Ballan MSc , Selma E. Kaffka genaamd Dengler MD , Veronique M.F. Meijborg PhD , Saskia C.A. de Jager PhD , Richard Van Wijk PhD , Niels P. van der Kaaij MD, PhD

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.

低温氧合灌注（HOPE）是一种新兴的供体心脏保存技术，目前正在多项临床试验中进行研究，结果令人鼓舞。与其他器官的 HOPE 相比，心脏方案涉及补充红细胞 (RBC)，尽管没有比较证据证明其益处。在本视角论文中，我们将讨论在心脏 HOPE 期间补充红细胞的利弊。尽管目前在 HOPE 期间补充 RBC 的临床效果似乎很好，但也不能排除补充 RBC 的潜在弊端。在心脏 HOPE 期间补充 RBC 的影响需要进一步研究，以改进 HOPE 方案，从而利用这一前景看好的技术优化心脏保存。

引用次数: 0