Pub Date : 2025-11-23DOI: 10.1016/j.healun.2025.11.019
Vanessa Blumer MD , Michelle M. Kittleson MD , Kiran K. Khush MD, MAS , Ersilia M. DeFilippis MD
Since the implementation of the new allocation system for heart transplantation in 2018, various unintended consequences have emerged. In response, a recent policy amendment was proposed that took effect in September 2025 requiring transplant programs to document failure of inotropic therapy prior to the use of percutaneous endovascular mechanical circulatory support or intra-aortic balloon pump. The goal of this new policy is to reduce inflation and waitlist congestion of Status 2 and help to further risk stratify patients within the current Status 2 tier by waitlist urgency. This viewpoint highlights the potential anticipated challenges in response to this policy including rising exception requests, gaming of timing, potential delays in appropriate escalation of mechanical circulatory support, and considerations around health equity.
{"title":"Rethinking heart transplant allocation: Aligning urgency, equity, and outcomes","authors":"Vanessa Blumer MD , Michelle M. Kittleson MD , Kiran K. Khush MD, MAS , Ersilia M. DeFilippis MD","doi":"10.1016/j.healun.2025.11.019","DOIUrl":"10.1016/j.healun.2025.11.019","url":null,"abstract":"<div><div>Since the implementation of the new allocation system for heart transplantation in 2018, various unintended consequences have emerged. In response, a recent policy amendment was proposed that took effect in September 2025 requiring transplant programs to document failure of inotropic therapy prior to the use of percutaneous endovascular mechanical circulatory support or intra-aortic balloon pump. The goal of this new policy is to reduce inflation and waitlist congestion of Status 2 and help to further risk stratify patients within the current Status 2 tier by waitlist urgency. This viewpoint highlights the potential anticipated challenges in response to this policy including rising exception requests, gaming of timing, potential delays in appropriate escalation of mechanical circulatory support, and considerations around health equity.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 516-518"},"PeriodicalIF":6.0,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575437","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 : 2025-11-22DOI: 10.1016/j.healun.2025.11.009
Mary E. Teresczuk MD, Joseph W. Rossano MD
{"title":"Pediatric heart transplantation: We’ve come a long way but there is still a long way to go","authors":"Mary E. Teresczuk MD, Joseph W. Rossano MD","doi":"10.1016/j.healun.2025.11.009","DOIUrl":"10.1016/j.healun.2025.11.009","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 492-493"},"PeriodicalIF":6.0,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comments and opinions regarding “A randomized trial of open lung protective ventilation compared to conventional mechanical ventilation in deceased organ donors” by Ware LB et al.","authors":"Parth Aphale PhD , Himanshu Shekhar , Shashank Dokania","doi":"10.1016/j.healun.2025.07.030","DOIUrl":"10.1016/j.healun.2025.07.030","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Pages 2042-2043"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555095","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 : 2025-11-21DOI: 10.1016/j.healun.2025.07.013
Brijesh Sathian PhD, Javed Iqbal RN, MHA, Syed Muhammad Ali MBBS, FCPS
{"title":"Durable left ventricular assist device support in donation after circulatory death heart transplantation: Outcomes, risks, and emerging strategies","authors":"Brijesh Sathian PhD, Javed Iqbal RN, MHA, Syed Muhammad Ali MBBS, FCPS","doi":"10.1016/j.healun.2025.07.013","DOIUrl":"10.1016/j.healun.2025.07.013","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Pages 2045-2046"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555403","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 : 2025-11-21DOI: 10.1016/j.healun.2025.07.029
Guanyu Yang MSc, Qinjun Chu MD
{"title":"Comment on “A randomized trial of open lung protective ventilation compared to conventional mechanical ventilation in deceased organ donors”","authors":"Guanyu Yang MSc, Qinjun Chu MD","doi":"10.1016/j.healun.2025.07.029","DOIUrl":"10.1016/j.healun.2025.07.029","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Page 2040"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555099","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 : 2025-11-21DOI: 10.1016/j.healun.2025.11.020
Jamie L. Todd MD, MHS
{"title":"Beyond mechanics: Searching for biology in baseline lung allograft dysfunction","authors":"Jamie L. Todd MD, MHS","doi":"10.1016/j.healun.2025.11.020","DOIUrl":"10.1016/j.healun.2025.11.020","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 415-416"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145567307","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 : 2025-11-21DOI: 10.1016/j.healun.2025.11.015
Katherine A. Young MD
{"title":"Commentary: Pregnancy after lung transplantation − a complex interplay of risk and hope","authors":"Katherine A. Young MD","doi":"10.1016/j.healun.2025.11.015","DOIUrl":"10.1016/j.healun.2025.11.015","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 428-429"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145567313","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 : 2025-11-21DOI: 10.1016/j.healun.2025.10.017
Mark N. Belkin MD , Molly White MS , Alejandro Plana MD MS , Seyed Ehsan Saffari , Anthony J. Kanelidis MD , Valluvan Jeevanandam MD , Christopher Salerno MD , Ann B. Nguyen MD , Bow B. Chung MD , Sara Kalantari MD , Nitasha Sarswat MD , Gene Kim MD , Manreet Kanwar MD , Sean P. Pinney MD , William Parker , Jonathan Grinstein MD
Background
The association between invasive hemodynamics measurements at time of listing for heart transplantation and the outcome of removal from the waitlist for death or deterioration was evaluated.
Methods
Retrospective analysis of the Scientific Registry of Transplant Candidates, including all adults listed for heart transplant from October 2018 through December 2023 was completed. All patients with listing hemodynamics for statuses 1-4, and 6, were included, unless obtained while on mechanical circulatory support. Survival analyses was performed using competing risks regressions to assess the association between baseline hemodynamic parameters and 30-day and one-year outcomes. Results reported as sub-hazard ratios (HR) and 95% confidence intervals (CI).
Results
A total of 22,396 patients were listed for heart transplant, of which 14,079 patients met inclusion criteria. Aortic pulsatility index (API) < 1.45 (subHR 2.14 95%CI 1.64,2.79 p<0.001), left ventricular stroke work index (LVSWI) < 20 (subHR 2.37 95%CI 1.77,3.19 p <0.001), myocardial performance score (MPS) < 0.5 (subHR 2.15 95%CI 1.64,2.81 p<0.001), pulmonary capillary wedge pressure (PCWP) > 15 mmHg (subHR 2.15 95%CI 1.67,2.85 p<0.001), and systolic blood pressure (SBP) < 90 mmHg (subHR 2.19 95%CI 1.67,2.85 p<0.001) had the strongest association with the primary outcome. As continuous metrics, API and MPS were most strongly associated with the primary outcome.
Conclusions
API, LVSWI, MPS, PCWP, and SBP were the strongest predictors of transplant waitlist removal for death or deterioration of patients. The current heart transplant allocation system could be improved by incorporating more prognostic hemodynamic criteria for waitlist risk stratification.
{"title":"Association between listing hemodynamics and heart transplantation waitlist outcomes: An analysis of the Scientific Registry of Transplant Recipients","authors":"Mark N. Belkin MD , Molly White MS , Alejandro Plana MD MS , Seyed Ehsan Saffari , Anthony J. Kanelidis MD , Valluvan Jeevanandam MD , Christopher Salerno MD , Ann B. Nguyen MD , Bow B. Chung MD , Sara Kalantari MD , Nitasha Sarswat MD , Gene Kim MD , Manreet Kanwar MD , Sean P. Pinney MD , William Parker , Jonathan Grinstein MD","doi":"10.1016/j.healun.2025.10.017","DOIUrl":"10.1016/j.healun.2025.10.017","url":null,"abstract":"<div><h3>Background</h3><div>The association between invasive hemodynamics measurements at time of listing for heart transplantation and the outcome of removal from the waitlist for death or deterioration was evaluated.</div></div><div><h3>Methods</h3><div>Retrospective analysis of the Scientific Registry of Transplant Candidates, including all adults listed for heart transplant from October 2018 through December 2023 was completed. All patients with listing hemodynamics for statuses 1-4, and 6, were included, unless obtained while on mechanical circulatory support. Survival analyses was performed using competing risks regressions to assess the association between baseline hemodynamic parameters and 30-day and one-year outcomes. Results reported as sub-hazard ratios (HR) and 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>A total of 22,396 patients were listed for heart transplant, of which 14,079 patients met inclusion criteria. Aortic pulsatility index (API) < 1.45 (subHR 2.14 95%CI 1.64,2.79 <em>p</em><0.001), left ventricular stroke work index (LVSWI) < 20 (subHR 2.37 95%CI 1.77,3.19 <em>p</em> <0.001), myocardial performance score (MPS) < 0.5 (subHR 2.15 95%CI 1.64,2.81 <em>p</em><0.001), pulmonary capillary wedge pressure (PCWP) > 15 mmHg (subHR 2.15 95%CI 1.67,2.85 <em>p</em><0.001), and systolic blood pressure (SBP) < 90 mmHg (subHR 2.19 95%CI 1.67,2.85 <em>p</em><0.001) had the strongest association with the primary outcome. As continuous metrics, API and MPS were most strongly associated with the primary outcome.</div></div><div><h3>Conclusions</h3><div>API, LVSWI, MPS, PCWP, and SBP were the strongest predictors of transplant waitlist removal for death or deterioration of patients. The current heart transplant allocation system could be improved by incorporating more prognostic hemodynamic criteria for waitlist risk stratification.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 350-362"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145567308","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 : 2025-11-21DOI: 10.1016/S1053-2498(25)02355-1
{"title":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(25)02355-1","DOIUrl":"10.1016/S1053-2498(25)02355-1","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Page A2"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555070","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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