Pub Date : 2024-08-17DOI: 10.1016/j.healun.2024.08.004
Maria T Gamero, Yevgeniy Brailovsky, Howard J Eisen
{"title":"Going the distance: Long-term follow-up of the randomized, prospective Scandinavian heart transplant everolimus de novo study with early calcineurin inhibitors avoidance (SCHEDULE) trial.","authors":"Maria T Gamero, Yevgeniy Brailovsky, Howard J Eisen","doi":"10.1016/j.healun.2024.08.004","DOIUrl":"10.1016/j.healun.2024.08.004","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004324","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 : 2024-08-13DOI: 10.1016/j.healun.2024.08.008
Konrad Hoetzenecker, Caitlin Demarest, Philippe Lemaitre, Stephanie H Chang, Marcelo Cypel, Matthew Bacchetta
{"title":"Expert opinion-Avaricious bundled services of third-party lung procurement organizations.","authors":"Konrad Hoetzenecker, Caitlin Demarest, Philippe Lemaitre, Stephanie H Chang, Marcelo Cypel, Matthew Bacchetta","doi":"10.1016/j.healun.2024.08.008","DOIUrl":"10.1016/j.healun.2024.08.008","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988025","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 : 2024-08-12DOI: 10.1016/j.healun.2024.08.003
Denny Choi, Michelle North, Musawir Ahmed, Natalia Belousova, Anastasiia Vasileva, John Matelski, Lianne G Singer, Joyce K Y Wu, Cheol-Heon Jeong, Greg Evans, Chung-Wai Chow
Background: Exposure to air pollution post-lung transplant has been shown to decrease graft and patient survival. This study examines the impact of air pollution exposure in the first 3 months post-transplant on baseline (i.e., highest) forced expiratory volume in 1 second (FEV1) achieved and development of chronic lung allograft dysfunction (CLAD).
Methods: Double-lung transplant recipients (n = 82) were prospectively enrolled for comprehensive indoor and personal environmental monitoring at 6- and 12-week post transplant and followed for >4 years. Associations between clinical and exposure variables were investigated using an exposomics approach followed by analysis with a Cox proportional hazards model. Multivariable analyses were used to examine the impact of air pollution on baseline % predicted FEV1 (defined as the average of the 2 highest values post transplant) and risk of CLAD.
Results: Multivariable analysis revealed a significant inverse relationship between personal black carbon (BC) levels and baseline % FEV1. The multivariable model indicated that patients with higher-than-median exposure to BC (>350 ng/m3) attained a baseline % FEV1 that was 8.8% lower than those with lower-than-median BC exposure (p = 0.019). Cox proportional hazards model analysis revealed that patients with high personal BC exposure had a 2.4 times higher hazard risk for CLAD than patients with low BC exposure (p = 0.045).
Conclusions: Higher personal BC levels during the first 3 months post-transplant decrease baseline FEV1 and double the risk of CLAD. Strategies to reduce BC exposure early following a lung transplant may help improve lung function and long-term outcomes.
{"title":"Pollution exposure in the first 3 months post transplant is associated with lower baseline FEV<sub>1</sub> and higher CLAD risk.","authors":"Denny Choi, Michelle North, Musawir Ahmed, Natalia Belousova, Anastasiia Vasileva, John Matelski, Lianne G Singer, Joyce K Y Wu, Cheol-Heon Jeong, Greg Evans, Chung-Wai Chow","doi":"10.1016/j.healun.2024.08.003","DOIUrl":"10.1016/j.healun.2024.08.003","url":null,"abstract":"<p><strong>Background: </strong>Exposure to air pollution post-lung transplant has been shown to decrease graft and patient survival. This study examines the impact of air pollution exposure in the first 3 months post-transplant on baseline (i.e., highest) forced expiratory volume in 1 second (FEV<sub>1</sub>) achieved and development of chronic lung allograft dysfunction (CLAD).</p><p><strong>Methods: </strong>Double-lung transplant recipients (n = 82) were prospectively enrolled for comprehensive indoor and personal environmental monitoring at 6- and 12-week post transplant and followed for >4 years. Associations between clinical and exposure variables were investigated using an exposomics approach followed by analysis with a Cox proportional hazards model. Multivariable analyses were used to examine the impact of air pollution on baseline % predicted FEV<sub>1</sub> (defined as the average of the 2 highest values post transplant) and risk of CLAD.</p><p><strong>Results: </strong>Multivariable analysis revealed a significant inverse relationship between personal black carbon (BC) levels and baseline % FEV<sub>1</sub>. The multivariable model indicated that patients with higher-than-median exposure to BC (>350 ng/m<sup>3</sup>) attained a baseline % FEV<sub>1</sub> that was 8.8% lower than those with lower-than-median BC exposure (p = 0.019). Cox proportional hazards model analysis revealed that patients with high personal BC exposure had a 2.4 times higher hazard risk for CLAD than patients with low BC exposure (p = 0.045).</p><p><strong>Conclusions: </strong>Higher personal BC levels during the first 3 months post-transplant decrease baseline FEV<sub>1</sub> and double the risk of CLAD. Strategies to reduce BC exposure early following a lung transplant may help improve lung function and long-term outcomes.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982468","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 : 2024-08-12DOI: 10.1016/j.healun.2024.08.006
Jennifer A Cowger, Ezequiel Molina, Luqin Deng, Manreet Kanwar, Palak Shah, Rebecca Cogswell, Igor Gosev, Ryan S Cantor, Todd F Dardas, James K Kirklin, Joseph G Rogers, Joseph C Cleveland, Kristin E Sandau, Colleen K McIlvennan, David Kaczorowski, Jerry D Estep, Francis D Pagani
Background: Patients have substantial variability in perioperative outcomes after left ventricular assist device (LVAD) implant. A perioperative multidimensional tool integrating mortality, adverse events (AEs), and patient-reported outcomes to assist in quality improvement initiatives is needed.
Methods: Patients undergoing HeartMate 3 LVAD implant (January 1, 2017 to January 31, 2024) in the Society of Thoracic Surgeons' Intermacs registry were studied. Cox proportional hazard multivariable analyses incorporating AEs as time-varying covariates for mortality out to 180 days was used to generate the INtermacs Short term composITE quality score (INSITE score derivation), reflecting the adjusted hazard ratio (HR) for mortality contributed by each AE, applying the global ranking methodology. In those alive and on support at 6 months, multivariable logistic regression (odds ratio) was used to examine the impact of AEs on health-related quality of life (QOL) at 180 days, captured through the INSITE-QOL score. Failure to achieve ≥1 point increase in visual analog scale from baseline was the event.
Results: Of 13,148 patients, 4,389 (33.4%) suffered at least 1 AE or death through 180 days. Stroke (survival: HR 13.1; QOL: HR 1.7), dialysis (survival: HR 31.4; QOL: HR 4.2), prolonged respiratory failure (survival: HR 5.7; QOL: HR 2.3), reoperation (survival: HR 3.4; QOL: HR 1.6), and right heart failure (survival: 5.0; QOL: HR 1.4), contributed to both mortality and failure to improve QOL at 180 days (all p < 0.05). The median INSITE and INSITE-QOL scores were 0.0 [0.0, 1.6] and 0.0 [0.0, 0.0], respectively. At 9.4% (n = 17) of centers, a high INSITE score (≥13) was present in 15% of patients, while the top 25% of centers had perfect INSITE-QOL scores in at least 75% of patients.
Conclusions: AEs after LVAD confer differential impact on mortality and QOL, enabling the development of global rank outcome scores. Given the high mortality hazard conferred by 180-day AEs, center-specific quality interventions aimed at reducing early complications provide the greatest opportunity to improve long-term survival and QOL.
{"title":"Defining optimal left ventricular assist device short-term outcomes may provide insight into programmatic quality assessment.","authors":"Jennifer A Cowger, Ezequiel Molina, Luqin Deng, Manreet Kanwar, Palak Shah, Rebecca Cogswell, Igor Gosev, Ryan S Cantor, Todd F Dardas, James K Kirklin, Joseph G Rogers, Joseph C Cleveland, Kristin E Sandau, Colleen K McIlvennan, David Kaczorowski, Jerry D Estep, Francis D Pagani","doi":"10.1016/j.healun.2024.08.006","DOIUrl":"10.1016/j.healun.2024.08.006","url":null,"abstract":"<p><strong>Background: </strong>Patients have substantial variability in perioperative outcomes after left ventricular assist device (LVAD) implant. A perioperative multidimensional tool integrating mortality, adverse events (AEs), and patient-reported outcomes to assist in quality improvement initiatives is needed.</p><p><strong>Methods: </strong>Patients undergoing HeartMate 3 LVAD implant (January 1, 2017 to January 31, 2024) in the Society of Thoracic Surgeons' Intermacs registry were studied. Cox proportional hazard multivariable analyses incorporating AEs as time-varying covariates for mortality out to 180 days was used to generate the INtermacs Short term composITE quality score (INSITE score derivation), reflecting the adjusted hazard ratio (HR) for mortality contributed by each AE, applying the global ranking methodology. In those alive and on support at 6 months, multivariable logistic regression (odds ratio) was used to examine the impact of AEs on health-related quality of life (QOL) at 180 days, captured through the INSITE-QOL score. Failure to achieve ≥1 point increase in visual analog scale from baseline was the event.</p><p><strong>Results: </strong>Of 13,148 patients, 4,389 (33.4%) suffered at least 1 AE or death through 180 days. Stroke (survival: HR 13.1; QOL: HR 1.7), dialysis (survival: HR 31.4; QOL: HR 4.2), prolonged respiratory failure (survival: HR 5.7; QOL: HR 2.3), reoperation (survival: HR 3.4; QOL: HR 1.6), and right heart failure (survival: 5.0; QOL: HR 1.4), contributed to both mortality and failure to improve QOL at 180 days (all p < 0.05). The median INSITE and INSITE-QOL scores were 0.0 [0.0, 1.6] and 0.0 [0.0, 0.0], respectively. At 9.4% (n = 17) of centers, a high INSITE score (≥13) was present in 15% of patients, while the top 25% of centers had perfect INSITE-QOL scores in at least 75% of patients.</p><p><strong>Conclusions: </strong>AEs after LVAD confer differential impact on mortality and QOL, enabling the development of global rank outcome scores. Given the high mortality hazard conferred by 180-day AEs, center-specific quality interventions aimed at reducing early complications provide the greatest opportunity to improve long-term survival and QOL.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982441","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 : 2024-08-10DOI: 10.1016/j.healun.2024.08.002
Isabelle Etienne, Delphine Kemlin, Nicolas Gemander, Véronique Olislagers, Alexandra Waegemans, Emilie Dhondt, Leo Heyndrickx, Stéphanie Depickère, Alexia Charles, Maria Goossens, Leen Vandermosten, Isabelle Desombere, Kevin K Ariën, Pieter Pannus, Christiane Knoop, Arnaud Marchant
Lung transplant recipients (LTRs) are susceptible to severe Coronavirus Disease 2019 (COVID-19) and had lower immune responses to primary severe acute respiratory syndrome-related to coronavirus 2 (SARS-CoV-2) vaccination as compared to the general population and to other solid organ transplant recipients. As immunity induced by booster vaccination and natural infection has increased since the beginning of the pandemic in the general population, immunity acquired by LTRs is not well documented. Humoral and cellular immunity to SARS-CoV-2 was monitored in February and May 2023 in 30 LTRs and compared to that of health care workers (HCWs) and nursing home residents (NHRs). LTRs had significantly lower levels of SARS-CoV-2 binding and neutralizing antibodies and lower interferon-gamma responses to Wuhan, Delta, and XBB1.5 variants as compared to HCWs and NHRs. Humoral immunity decreased between the 2 visits, whereas cellular immunity remained more stable. The persistent defect in SARS-CoV-2 immunity in LTRs should encourage continued monitoring and preventive measures for this vulnerable population.
{"title":"Persistent defect in SARS-CoV-2 humoral and cellular immunity in lung transplant recipients.","authors":"Isabelle Etienne, Delphine Kemlin, Nicolas Gemander, Véronique Olislagers, Alexandra Waegemans, Emilie Dhondt, Leo Heyndrickx, Stéphanie Depickère, Alexia Charles, Maria Goossens, Leen Vandermosten, Isabelle Desombere, Kevin K Ariën, Pieter Pannus, Christiane Knoop, Arnaud Marchant","doi":"10.1016/j.healun.2024.08.002","DOIUrl":"10.1016/j.healun.2024.08.002","url":null,"abstract":"<p><p>Lung transplant recipients (LTRs) are susceptible to severe Coronavirus Disease 2019 (COVID-19) and had lower immune responses to primary severe acute respiratory syndrome-related to coronavirus 2 (SARS-CoV-2) vaccination as compared to the general population and to other solid organ transplant recipients. As immunity induced by booster vaccination and natural infection has increased since the beginning of the pandemic in the general population, immunity acquired by LTRs is not well documented. Humoral and cellular immunity to SARS-CoV-2 was monitored in February and May 2023 in 30 LTRs and compared to that of health care workers (HCWs) and nursing home residents (NHRs). LTRs had significantly lower levels of SARS-CoV-2 binding and neutralizing antibodies and lower interferon-gamma responses to Wuhan, Delta, and XBB1.5 variants as compared to HCWs and NHRs. Humoral immunity decreased between the 2 visits, whereas cellular immunity remained more stable. The persistent defect in SARS-CoV-2 immunity in LTRs should encourage continued monitoring and preventive measures for this vulnerable population.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971244","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 : 2024-08-10DOI: 10.1016/j.healun.2024.08.005
Jennifer Conway, Tara Pidborochynski, Diana Ly, Leah Mowat, Darren H Freed, Izak De Villiers Jonker, Mohammed Al-Aklabi, Paula Holinski, Vijay Anand, Holger Buchholz
For smaller pediatric patients on ventricular assist devices, the Berlin Heart EXCOR remains the main form of durable support. It requires a connection to the external IKUS, which has limited portability and battery life. The new EXCOR Active mobile driving unit has a battery life of up to 13 hours. We describe the first North American experience with the EXCOR Active in pediatric patients with a Berlin Heart device. A retrospective chart review was undertaken. Between October 2022 and March 2024, 7 patients were on a Berlin Heart and supported with the EXCOR Active. All patients were initially supported with the IKUS with a median time to transition to the EXCOR Active of 12.0 days (interquartile range [IQR] 9.5, 18.5) and a median time of support with the EXCOR Active of 65.0 days (IQR, 32.0, 81.0). The EXCOR Active posed no significant safety issues, and minimal operating issues were noted. Following the transition from IKUS to the EXCOR Active, there was increased patient and caregiver mobility throughout the hospital. Use of the EXCOR Active has the potential to improve the quality of life in pediatric patients waiting for heart transplantation.
对于使用心室辅助装置(VAD)的较小儿童患者,柏林心脏 EXCOR® 仍是主要的持久支持方式。它需要与外部 IKUS 连接,其便携性和电池寿命有限。新型 EXCOR® Active 移动驱动装置的电池寿命长达 13 小时。我们介绍了 EXCOR® Active 在北美首次用于使用柏林之心设备的儿童患者的经验。我们进行了回顾性病历审查。在 2022 年 10 月至 2024 年 3 月期间,有七名患者使用了柏林之心,并得到了 EXCOR® Active 的支持。所有患者最初都使用 IKUS 支持,过渡到 EXCOR® Active 的中位时间为 12.0 天(IQR 9.5,18.5),使用 EXCOR® Active 支持的中位时间为 65.0 天(IQR 32.0,81.0)。EXCOR® Active 不存在重大安全问题,操作问题也极少。从 IKUS 过渡到 EXCOR® Active 后,病人和护理人员在医院内的移动性增加了。使用 EXCOR® Active 有可能提高等待心脏移植的儿童患者的生活质量。
{"title":"First North American experience with the Berlin Heart EXCOR Active driver.","authors":"Jennifer Conway, Tara Pidborochynski, Diana Ly, Leah Mowat, Darren H Freed, Izak De Villiers Jonker, Mohammed Al-Aklabi, Paula Holinski, Vijay Anand, Holger Buchholz","doi":"10.1016/j.healun.2024.08.005","DOIUrl":"10.1016/j.healun.2024.08.005","url":null,"abstract":"<p><p>For smaller pediatric patients on ventricular assist devices, the Berlin Heart EXCOR remains the main form of durable support. It requires a connection to the external IKUS, which has limited portability and battery life. The new EXCOR Active mobile driving unit has a battery life of up to 13 hours. We describe the first North American experience with the EXCOR Active in pediatric patients with a Berlin Heart device. A retrospective chart review was undertaken. Between October 2022 and March 2024, 7 patients were on a Berlin Heart and supported with the EXCOR Active. All patients were initially supported with the IKUS with a median time to transition to the EXCOR Active of 12.0 days (interquartile range [IQR] 9.5, 18.5) and a median time of support with the EXCOR Active of 65.0 days (IQR, 32.0, 81.0). The EXCOR Active posed no significant safety issues, and minimal operating issues were noted. Following the transition from IKUS to the EXCOR Active, there was increased patient and caregiver mobility throughout the hospital. Use of the EXCOR Active has the potential to improve the quality of life in pediatric patients waiting for heart transplantation.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971243","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 : 2024-08-08DOI: 10.1016/j.healun.2024.05.010
The “International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024” updates and replaces the “Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates—2006” and the “2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update.” The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.
{"title":"International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024","authors":"","doi":"10.1016/j.healun.2024.05.010","DOIUrl":"10.1016/j.healun.2024.05.010","url":null,"abstract":"<div><p>The “International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024” updates and replaces the “Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates—2006” and the “2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update.” The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.</p></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053249824016796/pdfft?md5=04f22b2b4c139931736cd96f456ea388&pid=1-s2.0-S1053249824016796-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.healun.2024.08.001
Erik J Henricksen, Brian Wayda, Jeffrey J Teuteberg, Helen Luikart, Joyce Njoroge, Brandon A Guenthart, Kiran K Khush
Background: Patients of advanced age are often considered to be poor candidates for heart transplant (HT). As the U.S. population continues to age, it is important for clinicians to understand how best to select patients for advanced therapies.
Methods: This was a retrospective analysis of the U.S. Scientific Registry of Transplant Recipients data from 2006 to August 2022 in adult recipients. Patients were excluded if they were multiorgan transplant, re-do transplants, or less than 1 year post transplant.
Results: Recipients ≥70 had a 1-year survival of 87.5%, compared to 91.1% for <60%, and 88.4% for 60-69 years (p < 0.001). Survival improved numerically, but not significantly, as transplant eras progressed for those ≥70 years. Survival by Kaplan-Meier analysis was greatest at 5 years for <60 years (80.6%), compared to 60-69 years (78.2%) and ≥70 years (77.1%). When comparing 60-69 years to ≥70 years by this same metric, there was significant difference (p = 0.12). One year survival for those ≥70 years has improved from 2000-2009 (80.7%) to 88.5% since October 2018 (p < 0.001). As recipients increased in age, they were more likely to be male, and less likely to be Black or Hispanic/Latino (p < 0.001).
Conclusion: Overall, HT outcomes are excellent for carefully selected patients ≥70 years, and transplanting patients in this age cohort can be considered.
{"title":"Trends in heart transplant outcomes for patients over the age of 70 years in the United States: An analysis of the scientific registry of transplant recipients database.","authors":"Erik J Henricksen, Brian Wayda, Jeffrey J Teuteberg, Helen Luikart, Joyce Njoroge, Brandon A Guenthart, Kiran K Khush","doi":"10.1016/j.healun.2024.08.001","DOIUrl":"10.1016/j.healun.2024.08.001","url":null,"abstract":"<p><strong>Background: </strong>Patients of advanced age are often considered to be poor candidates for heart transplant (HT). As the U.S. population continues to age, it is important for clinicians to understand how best to select patients for advanced therapies.</p><p><strong>Methods: </strong>This was a retrospective analysis of the U.S. Scientific Registry of Transplant Recipients data from 2006 to August 2022 in adult recipients. Patients were excluded if they were multiorgan transplant, re-do transplants, or less than 1 year post transplant.</p><p><strong>Results: </strong>Recipients ≥70 had a 1-year survival of 87.5%, compared to 91.1% for <60%, and 88.4% for 60-69 years (p < 0.001). Survival improved numerically, but not significantly, as transplant eras progressed for those ≥70 years. Survival by Kaplan-Meier analysis was greatest at 5 years for <60 years (80.6%), compared to 60-69 years (78.2%) and ≥70 years (77.1%). When comparing 60-69 years to ≥70 years by this same metric, there was significant difference (p = 0.12). One year survival for those ≥70 years has improved from 2000-2009 (80.7%) to 88.5% since October 2018 (p < 0.001). As recipients increased in age, they were more likely to be male, and less likely to be Black or Hispanic/Latino (p < 0.001).</p><p><strong>Conclusion: </strong>Overall, HT outcomes are excellent for carefully selected patients ≥70 years, and transplanting patients in this age cohort can be considered.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912959","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 : 2024-08-07DOI: 10.1016/j.healun.2024.07.025
Het Patel, Leonie Dupuis, Matthew Bacchetta, Antonio Hernandez, Manreet K Kanwar, JoAnn Lindenfeld, Zubair Shah, Hasan K Siddiqi, Shashank S Sinha, Ashish S Shah, Kelly H Schlendorf, Aniket S Rali
Background: Utilization of temporary mechanical circulatory support, including veno-arterial extra-corporeal membrane oxygenation as a bridge to heart transplantation (HT) has increased significantly under the revised United Network for Organ Sharing (UNOS) donor heart allocation system. The revised heart allocation system aimed to lower waitlist times and mortality for the most critically ill patients requiring biventricular, nondischargeable, mechanical circulatory support. While previous reports have shown improved 1-year post-HT survival in the current era, 3-year survival and factors associated with mortality among bridge-to-transplant (BTT) extra-corporeal membrane oxygenation (ECMO) patients are not well described.
Methods: We queried the UNOS database for all adult (age ≥ 18 years) heart-only transplants performed between 2010 and 2019. Patients were stratified as either pre- (January 2010-September 2018; era 1) or post-allocation change (November 2018-December 2019; era 2) cohort based on their HT date. Baseline recipient characteristics and post-transplant outcomes were compared. A Cox regression analysis was performed to explore risk factors for 3-year mortality among BTT-ECMO patients in era 2. For each era, 3-year mortality was also compared between BTT ECMO patients and those transplanted without ECMO support.
Results: During the study period, 116 patients were BTT ECMO during era 1 and 154 patients during era 2. Baseline recipient characteristics were similar in both groups. Median age was 48 (36-58 interquartile range (IQR)) years in era 2, while it was 51 (27-58 IQR) years in era 1. The majority of BTT-ECMO patients were males in both era 2 and era 1 (77.7% vs 71.5%, p = 0.28). Median ECMO run times while listed for HT were significantly shorter (4 days vs 7 days, p < 0.001) in era 2. Waitlist mortality among BTT ECMO patients was also significantly lower in era 2 (6.3% vs 19.3%, p < 0.001). Post-HT survival at 6 months (94.2% vs 75.9%, p < 0.001), 1 year (90.3% vs 74.2%, p < 0.001), and 3 years (87% vs 66.4%, p < 0.001) was significantly improved in era 2 as compared to era 1. Graft failure at 1 year (10.3% vs 25.8%, p = 0.0006) and 3 years (13.6% vs 33.6%, p = 0.0001) was also significantly lower in era 2 compared to era 1. Three-year survival among BTT ECMO patients in era 2 was similar to that of patients transplanted in era 2 without ECMO support (87% vs 85.7%, p = 0.75). In multivariable analysis of BTT-ECMO patients in era 2, every 1 kg/m2 increase in body mass index was associated with higher mortality at 3 years (hazard ratio (HR) 1.09, 95% CI 1.02-1.15, p = 0.006). Similarly, both post-HT stroke (HR 5.58, 95% CI 2.57-12.14, p < 0.001) and post-HT renal failure requiring hemodialysis (HR 4.36, 95% CI 2.43-7.82, p < 0.001) were also associated with 3-year mortality.
Conclusions: Three years post-HT survival in patients brid
{"title":"Three-year outcomes after bridge to transplantation ECMO-pre- and post-2018 UNOS revised heart allocation system.","authors":"Het Patel, Leonie Dupuis, Matthew Bacchetta, Antonio Hernandez, Manreet K Kanwar, JoAnn Lindenfeld, Zubair Shah, Hasan K Siddiqi, Shashank S Sinha, Ashish S Shah, Kelly H Schlendorf, Aniket S Rali","doi":"10.1016/j.healun.2024.07.025","DOIUrl":"10.1016/j.healun.2024.07.025","url":null,"abstract":"<p><strong>Background: </strong>Utilization of temporary mechanical circulatory support, including veno-arterial extra-corporeal membrane oxygenation as a bridge to heart transplantation (HT) has increased significantly under the revised United Network for Organ Sharing (UNOS) donor heart allocation system. The revised heart allocation system aimed to lower waitlist times and mortality for the most critically ill patients requiring biventricular, nondischargeable, mechanical circulatory support. While previous reports have shown improved 1-year post-HT survival in the current era, 3-year survival and factors associated with mortality among bridge-to-transplant (BTT) extra-corporeal membrane oxygenation (ECMO) patients are not well described.</p><p><strong>Methods: </strong>We queried the UNOS database for all adult (age ≥ 18 years) heart-only transplants performed between 2010 and 2019. Patients were stratified as either pre- (January 2010-September 2018; era 1) or post-allocation change (November 2018-December 2019; era 2) cohort based on their HT date. Baseline recipient characteristics and post-transplant outcomes were compared. A Cox regression analysis was performed to explore risk factors for 3-year mortality among BTT-ECMO patients in era 2. For each era, 3-year mortality was also compared between BTT ECMO patients and those transplanted without ECMO support.</p><p><strong>Results: </strong>During the study period, 116 patients were BTT ECMO during era 1 and 154 patients during era 2. Baseline recipient characteristics were similar in both groups. Median age was 48 (36-58 interquartile range (IQR)) years in era 2, while it was 51 (27-58 IQR) years in era 1. The majority of BTT-ECMO patients were males in both era 2 and era 1 (77.7% vs 71.5%, p = 0.28). Median ECMO run times while listed for HT were significantly shorter (4 days vs 7 days, p < 0.001) in era 2. Waitlist mortality among BTT ECMO patients was also significantly lower in era 2 (6.3% vs 19.3%, p < 0.001). Post-HT survival at 6 months (94.2% vs 75.9%, p < 0.001), 1 year (90.3% vs 74.2%, p < 0.001), and 3 years (87% vs 66.4%, p < 0.001) was significantly improved in era 2 as compared to era 1. Graft failure at 1 year (10.3% vs 25.8%, p = 0.0006) and 3 years (13.6% vs 33.6%, p = 0.0001) was also significantly lower in era 2 compared to era 1. Three-year survival among BTT ECMO patients in era 2 was similar to that of patients transplanted in era 2 without ECMO support (87% vs 85.7%, p = 0.75). In multivariable analysis of BTT-ECMO patients in era 2, every 1 kg/m<sup>2</sup> increase in body mass index was associated with higher mortality at 3 years (hazard ratio (HR) 1.09, 95% CI 1.02-1.15, p = 0.006). Similarly, both post-HT stroke (HR 5.58, 95% CI 2.57-12.14, p < 0.001) and post-HT renal failure requiring hemodialysis (HR 4.36, 95% CI 2.43-7.82, p < 0.001) were also associated with 3-year mortality.</p><p><strong>Conclusions: </strong>Three years post-HT survival in patients brid","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912958","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 : 2024-08-07DOI: 10.1016/j.healun.2024.07.024
Kevin J Clerkin, Lorenzo Sewanan, Jan M Griffin, Ersilia M DeFilippis, Boyu Peng, Margarita Chernovolenko, Erin Harris, Nikil Prasad, Paolo C Colombo, Melana Yuzefpolskaya, Justin Fried, Jayant Raikhelkar, Veli K Topkara, Michelle Castillo, Elaine Y Lam, Farhana Latif, Koji Takeda, Nir Uriel, Gabriel Sayer, Andrew J Einstein
Background: Cardiac hybrid positron emission tomography/computed tomography (PET/CT) has become a valid screening modality for cardiac allograft vasculopathy (CAV) following heart transplantation (HT). Visually estimated coronary artery calcium (VECAC) can be quantified from CT images obtained as part of PET/CT and has been shown to be associated with adverse cardiovascular outcomes in coronary artery disease. We investigated the prognostic value of VECAC following HT.
Methods: A retrospective analysis of 430 consecutive adult HT patients who underwent 13N-ammonia cardiac PET/CT from 2016 to 2019 with follow-up through October 15, 2022, was performed. VECAC categories included: VECAC 0, VECAC 1-9, VECAC 10-99, and VECAC 100+. The association between VECAC categories and outcomes was assessed using univariable and multivariable proportional hazards regression. The primary outcome was death/retransplantation.
Results: The cohort was 73% male, 33% had diabetes, 67% had estimated glomerular filtration rate <60 ml/min, median age was 61 years, and median time since HT was 7.5 years. VECAC alone was insufficiently sensitive to screen for CAV. During a median follow-up of 4.2 years ninety patients experienced death or retransplantation. Compared with those with VECAC 0, patients VECAC 10-99 (HR 2.25, 95% CI 1.23-4.14, p = 0.009) and VECAC 100+ (HR 3.42, 95% CI 1.96-5.99, p < 0.001) experienced an increased risk of death/retransplantation. The association was similar for cardiovascular death and cardiovascular hospitalization. After adjusting for other predictors of death/retransplantation, VECAC 10-99 (VECAC 10-99: aHR 1.95, 95% CI 1.03-3.71 p = 0.04) and VECAC 100+ (VECAC 100+: aHR 2.33, 95% CI 1.17-4.63, p = 0.02) remained independently associated with death/retransplantation.
Conclusions: VECAC is an independent prognostic marker of death/retransplantation following HT and merits inclusion as a part of post-HT surveillance PET/CT.
{"title":"Added prognostic value of visually estimated coronary artery calcium among heart transplant recipients.","authors":"Kevin J Clerkin, Lorenzo Sewanan, Jan M Griffin, Ersilia M DeFilippis, Boyu Peng, Margarita Chernovolenko, Erin Harris, Nikil Prasad, Paolo C Colombo, Melana Yuzefpolskaya, Justin Fried, Jayant Raikhelkar, Veli K Topkara, Michelle Castillo, Elaine Y Lam, Farhana Latif, Koji Takeda, Nir Uriel, Gabriel Sayer, Andrew J Einstein","doi":"10.1016/j.healun.2024.07.024","DOIUrl":"10.1016/j.healun.2024.07.024","url":null,"abstract":"<p><strong>Background: </strong>Cardiac hybrid positron emission tomography/computed tomography (PET/CT) has become a valid screening modality for cardiac allograft vasculopathy (CAV) following heart transplantation (HT). Visually estimated coronary artery calcium (VECAC) can be quantified from CT images obtained as part of PET/CT and has been shown to be associated with adverse cardiovascular outcomes in coronary artery disease. We investigated the prognostic value of VECAC following HT.</p><p><strong>Methods: </strong>A retrospective analysis of 430 consecutive adult HT patients who underwent <sup>13</sup>N-ammonia cardiac PET/CT from 2016 to 2019 with follow-up through October 15, 2022, was performed. VECAC categories included: VECAC 0, VECAC 1-9, VECAC 10-99, and VECAC 100+. The association between VECAC categories and outcomes was assessed using univariable and multivariable proportional hazards regression. The primary outcome was death/retransplantation.</p><p><strong>Results: </strong>The cohort was 73% male, 33% had diabetes, 67% had estimated glomerular filtration rate <60 ml/min, median age was 61 years, and median time since HT was 7.5 years. VECAC alone was insufficiently sensitive to screen for CAV. During a median follow-up of 4.2 years ninety patients experienced death or retransplantation. Compared with those with VECAC 0, patients VECAC 10-99 (HR 2.25, 95% CI 1.23-4.14, p = 0.009) and VECAC 100+ (HR 3.42, 95% CI 1.96-5.99, p < 0.001) experienced an increased risk of death/retransplantation. The association was similar for cardiovascular death and cardiovascular hospitalization. After adjusting for other predictors of death/retransplantation, VECAC 10-99 (VECAC 10-99: aHR 1.95, 95% CI 1.03-3.71 p = 0.04) and VECAC 100+ (VECAC 100+: aHR 2.33, 95% CI 1.17-4.63, p = 0.02) remained independently associated with death/retransplantation.</p><p><strong>Conclusions: </strong>VECAC is an independent prognostic marker of death/retransplantation following HT and merits inclusion as a part of post-HT surveillance PET/CT.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912957","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}