Journal of Heart and Lung Transplantation最新文献

Background: The effect of Friday the 13th and Full Moons on cardiac transplantation is unknown. We investigated the impact of these superstitious events on recipient and donor qualities, complications, survival, and volume.

Methods: All adult transplants from 2013-2023 in the United Network for Organ Sharing database were retrospectively reviewed. Friday the 13th recipients were compared to Adjacent Friday recipients and all other recipients. Full Moon recipients were compared to New Moon recipients and all other transplants. Recipient and donor characteristics were statistically compared, and outcomes including transplant volume, frequency, complications, and survival were assessed between groups before, and after, the 2018 allocation change.

Results: One thousand and twenty transplants occurred on a Full Moon, and 134 occurred on a Friday the 13th. No differences between donors, recipients, or outcomes and volume across eras were found in the Lunar analysis (all p > 0.05). Compared to Adjacent Friday recipients, but not to the control group, Friday the 13th recipients had higher rates of severe functional impairment (44% vs 41%), longer admissions before transplant (4 vs 1 day), and a higher prevalence of intensive care unit placement (40% vs 35%) (all p < 0.05). However, no differences were found in donor characteristics, outcomes, survival, or volume in either era (all p > 0.05).

Conclusions: There is likely no substantial adverse or unlucky influence of the Full Moon or Friday the 13th on cardiac transplantation. However, perceived stress has demonstrated effects on medical outcomes and health system functioning. Therefore, further research should investigate the persistence of these beliefs in health care settings.

Background: A pediatric national heart review board (NHRB) and exception guidance document to standardize decision-making were implemented in 2021 to reduce variability and ensure equity in status exceptions for pediatric candidates. We evaluated the hypothesis that these changes decreased center variability and racial disparities within the granted exceptions.

Methods: Guidance document and pediatric NHRB were operational by February and June 2021, respectively. Candidates were stratified by listing date into: Era 1, pre-policy changes (July 2018 - June 2020) and Era 2, post-policy changes (July 2021 - June 2023). Mixed effects logistic regression models evaluated individual and center-level predictors of receiving status 1A and 1B exceptions (E) pre- and post-policy implementation.

Results: Of 1,275 Era 1 listees, 15% received a 1A(E), with significant center variation. Black listees had lower likelihood of receiving 1A(E) (OR 0.57 [95% CI 0.34 - 0.94]), controlling for age, diagnosis, and center effects. Among 1,369 Era 2 listees, 14% received status 1A(E). Race was not associated with 1A(E), when controlling for the same variables, and center effect was not significant. While children listed 1B(E) increased from 12% to 16% from Era 1 to Era 2, in both eras, Black children were less likely to receive 1B(E) (OR 0.56 [95% CI 0.33 - 0.94) in Era 1, and 0.56 [0.34 - 0.91]) in Era 2). Center effect was significant in both eras.

Conclusions: Since implementing exception guidance and a pediatric review board, variation by center and patient race/ethnicity in 1A exceptions has been reduced. Center variation and racial disparities persist among 1B exceptions.

Background: Liquid biopsy offers a potential alternative to decrease or eliminate endomyocardial biopsy for diagnosing allograft rejection. p-element-induced wimpy testis-interacting RNAs (piRNAs) are novel and promising disease biomarkers for their intrinsic characteristics such as stability in body fluids; however, their role in allograft rejection remains unexplored.

Methods: A training set based on small RNA sequencing technology was performed to identify piRNAs in endomyocardial tissue (n = 8) and serum samples (n = 40) from patients following heart transplantation. A validation set of the potential piRNAs identified in the training study was conducted in an independent larger cohort for the detection of acute cellular rejection (ACR, n = 105) and antibody-mediated rejection (AMR, n = 61).

Results: We identified 20,292 piRNAs in endomyocardial tissue and 24,602 piRNAs in serum samples from patients following heart transplantation. We identified 7 piRNAs with a coincident expression profile in both types of samples and potential capacity for the noninvasive detection of cardiac rejection. Validation in a large independent cohort demonstrated that a panel of these piRNAs showed excellent performance for detecting grade ≥2R ACR (area under the receiver operating characteristic curve [AUC] = 0.819; p < 0.0001) and grade 1R ACR (AUC = 0.721; p = 0.001). Furthermore, our piRNA panel showed a potential discrimination ability of pAMR2 (AUC = 0.967; p < 0.0001).

Conclusions: To the best of knowledge, this study is the first to report the presence of piRNAs in both endomyocardial tissue and serum samples of patients after heart transplant, including their association with allograft rejection events. We propose a novel piRNA panel for the detection of cardiac allograft rejection.