Pub Date : 2025-11-21DOI: 10.1016/j.healun.2025.11.018
Joseph B. Lerman MD, Stuart D. Russell
{"title":"Pressure points: Hemodynamics and waitlist risk before heart transplant","authors":"Joseph B. Lerman MD, Stuart D. Russell","doi":"10.1016/j.healun.2025.11.018","DOIUrl":"10.1016/j.healun.2025.11.018","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 363-364"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145567311","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.2025.08.014
Lorraine B. Ware MD , Tatsuki Koyama PhD , Ciara M. Shaver MD, PhD , Michael A. Matthay MD
{"title":"Reply to “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":"Lorraine B. Ware MD , Tatsuki Koyama PhD , Ciara M. Shaver MD, PhD , Michael A. Matthay MD","doi":"10.1016/j.healun.2025.08.014","DOIUrl":"10.1016/j.healun.2025.08.014","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Page 2044"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555096","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.2025.06.027
Shivank Madan MD, MHA , Omar Saeed MD , Daniel J. Goldstein MD , Ulrich P. Jorde MD
{"title":"Navigating increasing donor age and extended preservation times with machine perfusion","authors":"Shivank Madan MD, MHA , Omar Saeed MD , Daniel J. Goldstein MD , Ulrich P. Jorde MD","doi":"10.1016/j.healun.2025.06.027","DOIUrl":"10.1016/j.healun.2025.06.027","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Pages 2035-2036"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555097","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.2025.11.001
Martin Strueber
{"title":"Warm ischemia and heart transplantation","authors":"Martin Strueber","doi":"10.1016/j.healun.2025.11.001","DOIUrl":"10.1016/j.healun.2025.11.001","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 347-349"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145567309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub 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":"2025-11-21","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 : 2025-11-21DOI: 10.1016/j.healun.2025.07.027
Yeahwa Hong M.D., Ph.D. , David J. Kaczorowski M.D.
{"title":"Reassessing the impact of ex vivo heart perfusion in donation after brain death heart transplantation","authors":"Yeahwa Hong M.D., Ph.D. , David J. Kaczorowski M.D.","doi":"10.1016/j.healun.2025.07.027","DOIUrl":"10.1016/j.healun.2025.07.027","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 12","pages":"Pages 2037-2039"},"PeriodicalIF":6.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555098","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}
Direct oral anticoagulants (DOACs) are widely used in chronic thromboembolic pulmonary hypertension (CTEPH); however, the safety and efficacy of reduced-dose regimens remain unclear. We retrospectively analyzed 721 follow-up selective pulmonary angiograms from 239 patients who completed balloon pulmonary angioplasty and received long-term anticoagulation with low-dose DOACs, standard-dose DOACs, or vitamin K antagonists (VKAs). Baseline characteristics, follow-up outcomes, and the incidence of pulmonary artery fresh floating thrombi were compared using the Kruskal-Wallis and Fisher’s exact tests.
Patients on low-dose DOACs were older, had lower body weights and more frequent renal impairment. Fresh thrombi were identified in 22 cases (3.1%), with a higher incidence in the low-dose DOAC (11.0%) group versus standard-dose (2.1%, p = 0.044) and VKAs (2.5%, p = 0.018). Hemodynamic improvements were comparable across groups. Low-dose DOACs were associated with a higher thrombus rate, suggesting potential under-anticoagulation. These findings highlight the need for CTEPH-specific anticoagulation strategies to balance thrombotic and bleeding risks.
{"title":"Pulmonary artery fresh floating thrombus in patients with chronic thromboembolic pulmonary hypertension on low-dose direct oral anticoagulants: A single-center angiographic observational study","authors":"Takeshi Suetomi MD, PhD , Hiroto Shimokawahara MD, PhD , Keiichiro Kuronuma MD, PhD , Yoichi Sugiyama MD, PhD , Ayane Miyagi MD , Yoshitake Fukuda MD , Misaki Kanezawa MD , Kazuki Suruga MD, PhD , Kazuna Hayashi MD , Soichiro Kobashi MD , Masataka Shigetoshi MD, PhD , Isao Tabuchi MD, PhD , Aiko Ogawa MD, PhD , Atsuyuki Watanabe MD, PhD , Takeshi Yamamoto MD, PhD , Hiromi Matsubara MD, PhD","doi":"10.1016/j.healun.2025.10.031","DOIUrl":"10.1016/j.healun.2025.10.031","url":null,"abstract":"<div><div>Direct oral anticoagulants (DOACs) are widely used in chronic thromboembolic pulmonary hypertension (CTEPH); however, the safety and efficacy of reduced-dose regimens remain unclear. We retrospectively analyzed 721 follow-up selective pulmonary angiograms from 239 patients who completed balloon pulmonary angioplasty and received long-term anticoagulation with low-dose DOACs, standard-dose DOACs, or vitamin K antagonists (VKAs). Baseline characteristics, follow-up outcomes, and the incidence of pulmonary artery fresh floating thrombi were compared using the Kruskal-Wallis and Fisher’s exact tests.</div><div>Patients on low-dose DOACs were older, had lower body weights and more frequent renal impairment. Fresh thrombi were identified in 22 cases (3.1%), with a higher incidence in the low-dose DOAC (11.0%) group versus standard-dose (2.1%, <em>p</em> = 0.044) and VKAs (2.5%, <em>p</em> = 0.018). Hemodynamic improvements were comparable across groups. Low-dose DOACs were associated with a higher thrombus rate, suggesting potential under-anticoagulation. These findings highlight the need for CTEPH-specific anticoagulation strategies to balance thrombotic and bleeding risks.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 452-456"},"PeriodicalIF":6.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531214","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 : 2025-11-14DOI: 10.1016/j.healun.2025.11.005
Martina Mackova PhD , Patrick Gauthier PhD , Jessica Chang BSc , Alim Hirji MD MSc , Justin Weinkauf MD , Stephen Juvet MD, PhD , Shaf Keshavjee MD, MSc , Jan Havlin MD, PhD , Robert Lischke MD, PhD , Andrea Zajacova MD , Greg Snell MBBS, FRACP MD , Glen Westall MBBS FRACP PhD, PhD , Philip F. Halloran MD, PhD , Kieran Halloran MD, MSc
Background
Baseline lung allograft dysfunction (BLAD) is a state of abnormally low peak post-transplant lung function, but the mechanisms are poorly understood. In this study, we examined transbronchial biopsy (TBB) gene expression changes associated with BLAD in an international cohort of prospectively enrolled lung transplant recipients.
Methods
BLAD status was assessed at 1-year post-transplant and defined as failure to reach normal lung function, as defined by a forced expiratory volume in 1 s and a forced vital capacity > 80% predicted on two consecutive occasions > 3 weeks apart. We used genome-wide microarray measurements in 252 TBBs obtained during the first post-transplant year from 214 double lung transplant recipients to identify top genes and pathogenesis-based transcript sets in BLAD and develop a molecular BLAD classifier.
Results
BLAD at 1-year post-transplant was diagnosed in 41% of patients and was more frequent in patients with interstitial lung disease (ILD) as transplant indication. TBBs from patients with BLAD showed increased transcripts associated with T cell-mediated rejection (TCMR) and cytotoxic T cell burden. BLAD biopsies were more likely to be classified as TCMR archetype – despite no differences in histology – and low surfactant archetype and less likely to be classified as no rejection. A molecular classifier developed to predict BLAD showed modest performance (AUC 0.58), which improved to 0.64 with the inclusion of clinical variables.
Conclusions
TBBs obtained during the first post-transplant year from patients with BLAD exhibit more frequent molecular features of TCMR not detected by histology, suggesting undetected or undertreated rejection may be contributing to poorer post-transplant lung function.
{"title":"Molecular biopsy features associated with baseline lung allograft dysfunction in a multicenter international cohort","authors":"Martina Mackova PhD , Patrick Gauthier PhD , Jessica Chang BSc , Alim Hirji MD MSc , Justin Weinkauf MD , Stephen Juvet MD, PhD , Shaf Keshavjee MD, MSc , Jan Havlin MD, PhD , Robert Lischke MD, PhD , Andrea Zajacova MD , Greg Snell MBBS, FRACP MD , Glen Westall MBBS FRACP PhD, PhD , Philip F. Halloran MD, PhD , Kieran Halloran MD, MSc","doi":"10.1016/j.healun.2025.11.005","DOIUrl":"10.1016/j.healun.2025.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Baseline lung allograft dysfunction (BLAD) is a state of abnormally low peak post-transplant lung function, but the mechanisms are poorly understood. In this study, we examined transbronchial biopsy (TBB) gene expression changes associated with BLAD in an international cohort of prospectively enrolled lung transplant recipients.</div></div><div><h3>Methods</h3><div>BLAD status was assessed at 1-year post-transplant and defined as failure to reach normal lung function, as defined by a forced expiratory volume in 1 s and a forced vital capacity > 80% predicted on two consecutive occasions > 3 weeks apart. We used genome-wide microarray measurements in 252 TBBs obtained during the first post-transplant year from 214 double lung transplant recipients to identify top genes and pathogenesis-based transcript sets in BLAD and develop a molecular BLAD classifier.</div></div><div><h3>Results</h3><div>BLAD at 1-year post-transplant was diagnosed in 41% of patients and was more frequent in patients with interstitial lung disease (ILD) as transplant indication. TBBs from patients with BLAD showed increased transcripts associated with T cell-mediated rejection (TCMR) and cytotoxic T cell burden. BLAD biopsies were more likely to be classified as TCMR archetype – despite no differences in histology – and low surfactant archetype and less likely to be classified as no rejection. A molecular classifier developed to predict BLAD showed modest performance (AUC 0.58), which improved to 0.64 with the inclusion of clinical variables.</div></div><div><h3>Conclusions</h3><div>TBBs obtained during the first post-transplant year from patients with BLAD exhibit more frequent molecular features of TCMR not detected by histology, suggesting undetected or undertreated rejection may be contributing to poorer post-transplant lung function.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 403-414"},"PeriodicalIF":6.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1016/j.healun.2025.10.012
Alexander R. Berg BS, Aravind Krishnan MD, Elbert E. Heng MD, Ashley Y. Choi MD, MHS, Alyssa C. Garrison MS, Daniel I. Alnasir BS, Chawannuch Ruaengsri MD, Yasuhiro Shudo MD, PHD, Y. Joseph Woo MD, John W. MacArthur MD
Background
Warm ischemic injury during the agonal period (AP) threatens graft viability in donation-after-circulatory-death (DCD) heart transplantation. Whether ex vivo heart perfusion (EVHP) mitigates these risks remains unclear.
Methods
Adult (≥18 years) isolated heart transplants reported to the United Network for Organ Sharing (UNOS) thoracic registry (January 2019-April 2025) were reviewed. Recipients lacking AP or perfusion data were excluded. The primary exposure was EVHP, defined as use of an ex vivo perfusion device following donor cardiectomy; static cold storage served as the reference. Multivariable Cox and logistic models adjusted for donor, recipient, procedural, and center-level factors. Propensity score matching was performed in the prolonged AP subgroup.
Results
Among 1,682 donation after circulatory death (DCD) recipients, 1,175 (69.9%) received ex vivo heart perfusion (EVHP). Prolonged AP (≥30 min) occurred in 359 cases. One-year survival was 90.7% overall. In the fully adjusted Cox model, no-EVHP grafts with AP ≥30 min had higher 1-year mortality versus the reference (no-EVHP + <30 min) (HR 2.17; 95% CI 1.05-4.47; p = 0.037). EVHP grafts showed no excess risk regardless of AP (EVHP + <30 min: HR 0.93; 95% CI 0.54-1.62; p = 0.809; EVHP + ≥30 min: HR 0.98; 95% CI 0.49-1.96; p = 0.953). Age, creatinine, out-of-body time, and adult congenital heart disease (ACHD) increased mortality; ventricular assist device (VAD) at listing and high-volume centers were protective; sex was not significant. In the AP ≥30-min propensity score matching (PSM) subgroup (n = 240; 120 EVHP, 120 no EVHP), EVHP improved 1-year survival (log-rank p = 0.03). Spline modeling showed rising mortality beginning ∼20 min of AP for static-preserved grafts, with a flat risk curve under EVHP. Static-preserved prolonged-AP grafts had higher odds of acute rejection before discharge (aOR 2.56; 95% CI 1.07-6.14; p = 0.04); stroke, dialysis, and pacemaker use did not differ.
Conclusions
EVHP may mitigate survival and rejection penalties of prolonged AP in the U.S. DCD heart transplantation. Broader EVHP adoption for donors with AP ≥30 min may safely expand the DCD heart pool without compromising outcomes.
{"title":"Ex-vivo heart perfusion attenuates early post-transplant risk after prolonged agonal period in DCD heart transplantation","authors":"Alexander R. Berg BS, Aravind Krishnan MD, Elbert E. Heng MD, Ashley Y. Choi MD, MHS, Alyssa C. Garrison MS, Daniel I. Alnasir BS, Chawannuch Ruaengsri MD, Yasuhiro Shudo MD, PHD, Y. Joseph Woo MD, John W. MacArthur MD","doi":"10.1016/j.healun.2025.10.012","DOIUrl":"10.1016/j.healun.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Warm ischemic injury during the agonal period (AP) threatens graft viability in donation-after-circulatory-death (DCD) heart transplantation. Whether ex vivo heart perfusion (EVHP) mitigates these risks remains unclear.</div></div><div><h3>Methods</h3><div>Adult (≥18 years) isolated heart transplants reported to the United Network for Organ Sharing (UNOS) thoracic registry (January 2019-April 2025) were reviewed. Recipients lacking AP or perfusion data were excluded. The primary exposure was EVHP, defined as use of an ex vivo perfusion device following donor cardiectomy; static cold storage served as the reference. Multivariable Cox and logistic models adjusted for donor, recipient, procedural, and center-level factors. Propensity score matching was performed in the prolonged AP subgroup.</div></div><div><h3>Results</h3><div>Among 1,682 donation after circulatory death (DCD) recipients, 1,175 (69.9%) received ex vivo heart perfusion (EVHP). Prolonged AP (≥30 min) occurred in 359 cases. One-year survival was 90.7% overall. In the fully adjusted Cox model, no-EVHP grafts with AP ≥30 min had higher 1-year mortality versus the reference (no-EVHP + <30 min) (HR 2.17; 95% CI 1.05-4.47; <em>p</em> = 0.037). EVHP grafts showed no excess risk regardless of AP (EVHP + <30 min: HR 0.93; 95% CI 0.54-1.62; <em>p</em> = 0.809; EVHP + ≥30 min: HR 0.98; 95% CI 0.49-1.96; <em>p</em> = 0.953). Age, creatinine, out-of-body time, and adult congenital heart disease (ACHD) increased mortality; ventricular assist device (VAD) at listing and high-volume centers were protective; sex was not significant. In the AP ≥30-min propensity score matching (PSM) subgroup (<em>n</em> = 240; 120 EVHP, 120 no EVHP), EVHP improved 1-year survival (log-rank <em>p</em> = 0.03). Spline modeling showed rising mortality beginning ∼20 min of AP for static-preserved grafts, with a flat risk curve under EVHP. Static-preserved prolonged-AP grafts had higher odds of acute rejection before discharge (aOR 2.56; 95% CI 1.07-6.14; <em>p</em> = 0.04); stroke, dialysis, and pacemaker use did not differ.</div></div><div><h3>Conclusions</h3><div>EVHP may mitigate survival and rejection penalties of prolonged AP in the U.S. DCD heart transplantation. Broader EVHP adoption for donors with AP ≥30 min may safely expand the DCD heart pool without compromising outcomes.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 337-346"},"PeriodicalIF":6.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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