Journal of Heart and Lung Transplantation最新文献

英文中文

Ex-vivo heart perfusion attenuates early post-transplant risk after prolonged agonal period in DCD heart transplantation 体外心脏灌注降低DCD心脏移植术后早期无心绞痛期的风险。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-13 DOI: 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.

背景：在循环死亡（DCD）心脏移植中，无痛期热缺血损伤（AP）会威胁移植物的生存能力。体外心脏灌注（EVHP）是否能减轻这些风险尚不清楚。离体方法：对UNOS胸科登记（2019年1月- 2025年4月）报告的成人（≥18岁）离体心脏移植进行回顾。排除无AP或灌注数据的受体。主要暴露是EVHP，定义为在供体心脏切除术后使用离体灌注装置；静态冷库作为参考。多变量Cox和logistic模型调整供体、受体、程序和中心水平因素。在延长AP亚组中进行倾向评分匹配。结果在1682例DCD患者中，1175例（69.9%）接受了EVHP治疗。AP延长（≥30 min） 359例。1年总体生存率为90.7%。在完全校正的Cox模型中，无evhp移植物AP≥30 min的1年死亡率高于对照（无evhp + <30 min）（HR 2.17; 95% CI 1.05-4.47; p=0.037）。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)。年龄、肌酐、体外时间和ACHD增加死亡率；上市中心和高交易量中心的VAD具有保护性；性别并不重要。在AP≥30分钟PSM亚组（n=240; EVHP 120，无EVHP 120）， EVHP改善了1年生存率（log-rank p=0.03）。样条模型显示，静态保存的移植物在AP开始~20分钟死亡率上升，EVHP下的风险曲线平坦。静态保存的延长ap移植物在出院前发生急性排斥反应的几率更高（aOR 2.56; 95% CI 1.07-6.14; p=0.04）；中风、透析和起搏器的使用没有差异。结论sevhp可减轻美国DCD心脏移植术后延长AP的生存和排斥反应。在AP≥30分钟的供者中更广泛地采用EVHP可以安全地扩大DCD心脏库，而不会影响结果。

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引用次数: 0

Donation after circulatory determination of death heart transplantation using simplified direct procurement: Expanding access 简化直接采购的DCD心脏移植：扩大可及性。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-13 DOI: 10.1016/j.healun.2025.10.020

Ioannis Dimarakis MD, PhD , Bassel Al-Alao MBBS , Charlene Tennyson MBBS , Mackenzie Adcox MD , David Edwards , Travis Bourland , Brent Beatty , Alexis Voitik , Bethany Sissom , Mackenzy Keller , Chris Figland , Jessica Gimelli , Peter Wong , Tony Li , Trang Bodtke , April Stempien-Otero MD , Richard K. Cheng MD , Jay D. Pal MD, PhD

Background

Donation after circulatory death (DCD) heart transplantation commonly relies on normothermic regional perfusion or ex vivo reanimation, both of which can be resource-intensive and operationally complex. To simplify procurement and mitigate logistical constraints, a direct procurement strategy employing oxygenated cold blood perfusion without reanimation was introduced. This study describes the early outcomes associated with this simplified technique.

Methods

A streamlined direct procurement protocol was implemented in five DCD heart donors. Hearts were recovered without the use of normothermic regional perfusion and were instead flushed with oxygenated cold blood perfusion followed by a standard preservation solution. Transplantation was performed using conventional implantation methods. Postoperative graft function, rejection events, and early clinical outcomes were assessed during short-term follow-up.

Results

All five transplant procedures were successfully completed. Recipients exhibited normal postoperative graft function with no evidence of rejection during the short-term follow-up period. The simplified procurement method proved feasible, operationally efficient, and less resource-dependent than existing reanimation-based techniques. Early results indicate that this approach may represent a cost-effective alternative for DCD heart recovery and may contribute to expanding the DCD donor pool.

本研究报告了一种简化的直接采购技术用于无常温区域灌注的循环死亡（DCD）心脏移植后捐赠的早期结果。5例移植成功，所有受者术后移植物功能正常，短期随访无排斥反应。结果表明，该方法是可行的，且物流效率高。研究结果表明，这种技术可能是一种具有成本效益的替代现有方法，支持其在扩大DCD供体池方面的潜在作用。

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引用次数: 0

Author’s response to Moeller et al. 作者对Moeller等人的回应。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-13 DOI: 10.1016/j.healun.2025.10.011

Anthony P. Carnicelli MD , Shashank S. Sinha MD, MSc , Song Li MD , Borui Li MA , Michele Esposito MD , Rachna Kataria MD , Arthur R. Garan MD , Van-Khue Ton MD, PhD , Kevin John MD , Elric Zweck MD , Jaime Hernandez-Montfort MD , Jacob Abraham MD , Daniel Burkhoff MD, PhD , Manreet K. Kanwar MD , Navin K. Kapur MD , On Behalf of the Cardiogenic Shock Working Group Academic Consortium

引用次数: 0

Not for the faint of heart—and yet: Donation after circulatory death simultaneous heart-kidney transplantation delivers 不适合心脏衰弱的人——然而：循环死亡后的捐赠同时进行心脏肾移植。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-13 DOI: 10.1016/j.healun.2025.10.025

Maria Francesca Scuppa MD , Guillaume Coutance MD, PhD

引用次数: 0

Advanced hemodynamics for right ventricular failure: Evaluating the use of the myocardial performance score 右心衰的高级血流动力学：评估心肌功能评分的使用。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-13 DOI: 10.1016/j.healun.2025.10.021

Jiho Han MD , Mikail Siddiki MD , Sara Kalantari MD , Mark N. Belkin MD , Jonathan Grinstein MD

Background

The purpose of the study is to assess a novel hemodynamic parameter, right ventricular myocardial performance score (RV-MPS), as a marker for right ventricular function and prognosis for advanced heart failure patients.

Methods

A total of 800 pressure-volume loop in silico simulations were performed at various hemodynamic conditions. RV-MPS was calculated as (3 × pulmonary artery pulsatility index [PAPI] × right ventricular cardiac power output [RV-CPO]) / 2. For the validation cohort, a total of 223 patients with advanced heart failure who underwent invasive hemodynamic testing from January 2013 to December 2019 were included. Advanced hemodynamic parameters, including RV-CPO, PAPI, and RV-MPS were calculated.

Results

In the simulation cohort, the median RV-CPO was (median 0.22, IQR: [0.08, 0.33] watts), RV coupling ratio was (median 1.3, IQR: [0.87, 1.85], and PAPI (median 2.2, IQR: [1.2, 3.5]), and the median RV-MPS was 0.74 (IQR: 0.19, 1.60). Simulations showed increases in RV E_ES and RV mechanical efficiency was associated with increase in RV-MPS for all conditions of stressed blood volume and arterial resistance. In the validation cohort, RV-MPS (OR: 0.64, 95% CI: [0.43, 0.97], p = 0.037), baseline creatinine (OR: 0.71, 95% CI: [0.51, 0.97], p = 0.32), and PCWP (OR: 1.05, 95% CI: [1.01, 1.10], p = 0.011) were independent predictors of composite outcome of death and need for heart replacement therapy at 1-year. Prior to left ventricular assist device implantation (n = 33), patients with RV-MPS <0.5 had significantly increased incidence of RV failure compared to patients with preserved RV-MPS ≥0.5 (66.7% vs. 16.7%, p = 0.003).

Conclusions

RV-MPS is a reliable estimator of RV function on in silico simulations. RV-MPS was an independent predictor of death or need for heart replacement therapy and may have a role in prognostication of advanced heart failure patients.

本研究的目的是评估一种新的血液动力学参数——右心室心肌功能评分（RV-MPS），作为晚期心力衰竭患者右心室功能和预后的标志。方法在不同的血流动力学条件下，对800个压力-体积环路进行了计算机模拟。RV-MPS计算为（3 ×肺动脉搏动指数[PAPI] ×右心室心输出功率[RV-CPO]） / 2。在验证队列中，共纳入了2013年1月至2019年12月接受有创血液动力学测试的223例晚期心力衰竭患者。计算高级血流动力学参数，包括RV-CPO、PAPI和RV-MPS。结果在模拟队列中，中位RV- cpo为（中位0.22,IQR:[0.08, 0.33]瓦），中位RV耦合比为(中位1.3,IQR: [0.87, 1.85]， PAPI为（中位2.2,IQR:[1.2, 3.5]），中位RV- mps为0.74 （IQR: 0.19, 1.60）。模拟显示，在所有应激血容量和动脉阻力条件下，RV EES和RV机械效率的增加与RV- mps的增加有关。在验证队列中，RV-MPS （OR: 0.64, 95% CI: [0.43, 0.97], p=0.037）、基线肌酐（OR: 0.71, 95% CI: [0.51, 0.97], p=0.32）和PCWP （OR: 1.05, 95% CI: [1.01, 1.10], p=0.011）是1年死亡和需要心脏替代治疗复合结局的独立预测因子。在植入左心室辅助装置之前（n=33）， RV- mps <0.5的患者与保留RV- mps≥0.5的患者相比，RV衰竭的发生率显著增加（66.7% vs. 16.7%, p=0.003）。结论srv - mps在计算机模拟中是一个可靠的RV函数估计器。RV-MPS是死亡或需要心脏替代治疗的独立预测因子，可能在晚期心力衰竭患者的预后中起作用。

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引用次数: 0

Comments and opinions regarding “International Society for Heart and Lung Transplantation Consensus Statement on the Referral and Selection of Pediatric Lung Transplant Candidates”: Expanding role of living-donor lobar lung transplantation in pediatric patients 关于“国际心肺移植学会关于儿童肺移植候选者转诊和选择的共识声明”：扩大活体供体大叶肺移植在儿科患者中的作用的评论和意见

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-12 DOI: 10.1016/j.healun.2025.10.023

Satona Tanaka , Daisuke Nakajima , Hiroshi Date

引用次数: 0

I can breathe again, and the best is yet to come—understanding quality of life after lung transplantation 我又能呼吸了，最好的还在后面——了解肺移植后的生活质量。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-12 DOI: 10.1016/j.healun.2025.10.033

Kelly M. Pennington MD , Sahar A. Saddoughi MD, PhD

引用次数: 0

Beyond the incision: Integrating mechanical circulatory support and less-invasive approaches in lung transplantation 超越切口：在肺移植中整合机械循环支持和微创入路。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-12 DOI: 10.1016/j.healun.2025.10.015

Norihisa Shigemura MD, PhD , Chadi A. Hage MD

引用次数: 0

“Advanced hemodynamics”—moving the field forward “高级血液动力学” -推动该领域向前发展

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-12 DOI: 10.1016/j.healun.2025.11.006

Susanna Mak MD, PhD

引用次数: 0

Follow the lead of the Valiant − heart transplantation after prolonged donor ischemia time 延长供体缺血时间对英勇心脏移植的影响。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-11-12 DOI: 10.1016/j.healun.2025.10.018

John M. Trahanas, Aaron M. Williams

引用次数: 0

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Journal of Heart and Lung Transplantation

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