Journal of Heart and Lung Transplantation最新文献

英文中文

Post-transplant outcomes by bridging strategy: A nationwide multicenter study of heart transplant recipients in Korea 通过桥接策略的移植后结果：韩国心脏移植受者的一项全国性多中心研究。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-10-02 DOI: 10.1016/j.healun.2025.09.023

Darae Kim , Kyu-Sun Lee , Yang Hyun Cho , Hae-Young Lee , Myoung Soo Kim , Hyungseop Kim , Dong-Ju Choi , Sang Eun Lee , Seok-Min Kang , Soo Yong Lee , Hyun-Jai Cho , Jin-Oh Choi , on behalf of KOTRY study group

Background

Extracorporeal membrane oxygenation (ECMO) is prioritized in Korea’s heart transplant (HTx) allocation system to reduce waitlist mortality, but post-transplant outcomes remain a concern. We compared post-transplant outcomes among HTx recipients bridged with ECMO, left ventricular assist device (LVAD), or without mechanical circulatory support (non-MCS).

Methods

We retrospectively analyzed 1021 adult HTx recipients enrolled in the Korean Organ Transplant Registry (2014-2023). Patients were categorized according to bridging strategy at transplantation (ECMO n = 357, LVAD n = 137, non-MCS n = 527). Outcomes included primary graft dysfunction (PGD), in-hospital mortality, any treated rejection, coronary allograft vasculopathy, infection requiring hospitalization, and post-transplant mortality.

Results

ECMO bridging was associated with significantly higher risks of severe PGD (adjusted HR 3.68 vs non-MCS; 2.23 vs LVAD). In-hospital mortality was highest in ECMO recipients (17.9%) compared with LVAD-bridged (4.4%) and non-MCS recipients (4.4%) (P < 0.001). Kaplan-Meier analysis demonstrated significantly lower survival in the ECMO group at 90 days (83.2% vs 94.8% vs 95.0%) and 1 year (77.5% vs 89.0% vs 92.5%) (log-rank p < 0.0001). However, in 6-month landmark analyses, survival was similar across groups. Among ECMO recipients, those who died within 6 months had a markedly higher prevalence of pre-transplant dialysis (66.7% vs 34.7%, p < 0.001). The incidence of treated rejection and CAV did not differ significantly among the three groups.

Conclusions

Direct ECMO bridging is associated with worse early post-transplant outcomes, primarily driven by severe PGD and early mortality, underscoring the need for careful candidate selection. LVAD bridging provided outcomes comparable to non-MCS and may offer a bridge-to-candidacy strategy for selected ECMO patients.

体外膜氧合（ECMO）在韩国心脏移植（HTx）分配系统中被优先考虑，以减少等待名单死亡率，但移植后的结果仍然令人担忧。我们比较了HTx受体在ECMO、左心室辅助装置（LVAD）或无机械循环支持（non-MCS）的桥接下的移植后结果。方法回顾性分析韩国器官移植登记处（2014-2023）登记的1021名成人HTx受者。根据移植时桥接策略对患者进行分类（ECMO n=357, LVAD n=137，非mcs n=527）。结果包括原发性移植物功能障碍（PGD）、住院死亡率、任何治疗后的排斥反应、冠状动脉移植血管病变、需要住院治疗的感染和移植后死亡率。结果secmo桥接与严重PGD的风险显著升高相关（调整后的HR为3.68 vs非mcs； 2.23 vs LVAD）。ECMO受者的住院死亡率最高（17.9%），高于lvad桥接（4.4%）和非mcs受者（4.4%）（p<0.001）。Kaplan-Meier分析显示，ECMO组90天生存率（83.2% vs. 94.8% vs. 95.0%）和1年生存率（77.5% vs. 89.0% vs. 92.5%）显著降低（log-rank p<0.0001）。然而，在6个月的里程碑分析中，各组的生存率相似。在ECMO受者中，6个月内死亡的患者移植前透析的患病率明显更高（66.7% vs. 34.7%, p<0.001）。治疗后的排斥反应和CAV的发生率在三组之间没有显著差异。结论：直接ECMO桥接与较差的移植后早期预后相关，主要是由严重的PGD和早期死亡率驱动的，强调了谨慎选择候选者的必要性。LVAD桥接提供了与非mcs相当的结果，并可能为选定的ECMO患者提供候选策略的桥梁。

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引用次数: 0

Endothelin-1 overexpression in pulmonary endarterectomy specimens of CTEPH patients is associated with pulmonary hypertension development 内皮素-1在CTEPH患者肺内膜切除术标本中的过度表达与肺动脉高压的发生有关。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-25 DOI: 10.1016/j.healun.2025.09.013

Usman Asghar , Hon-Sum Jeffrey Man , Micheal McInnis , Aly Muhammad Ladak , Susanna Mak , John Thomas Granton , Marc de Perrot

Background

Endothelin-1 (ET-1) is associated with pulmonary hypertension (PH) in pulmonary arterial hypertension patients. The role of ET-1 in chronic thromboembolic pulmonary hypertension (CTEPH) is not well defined. Therefore, we aimed to explore the contributions of organized thromboembolic material as a source of ET-1.

Methods

40 CTEPH patients with mPAP ≥ 50 mmHg (higher mPAP group) and 35 patients with mPAP ≤25 mmHg (lower mPAP group) who underwent pulmonary endarterectomy (PEA) were studied. Fresh frozen PEA samples were used to perform qRT-PCR, while paraffin samples were analyzed by immunohistochemistry staining for ET-1 quantification. Preoperative CT pulmonary angiograms were reviewed to assess the total number of vessel occlusions in the lungs of the higher mPAP and lower mPAP groups.

Results

The higher mPAP group showed significantly higher ET-1 protein (p < 0.0001) and mRNA (p=0.0003) expression in PEA specimens than the lower mPAP group. We found a positive ET-1 protein and mRNA correlation with transpulmonary resistance. CT scans showed no difference in overall obstruction of the pulmonary vascular tree between lower and higher mPAP groups (p=0.0929), but a significantly higher number of segmental (p=0.0362) and subsegmental vessels (p=0.0029) were blocked in the higher mPAP group. Overall, female patients had higher expression of ET-1 in the higher mPAP group as compared to the lower mPAP group and also had a significantly higher number of subsegmental vessels obstructed (p=0.0084).

Conclusions

ET-1 release from thromboembolic material of CTEPH patients could be an important mechanism leading to PH. Hence, ET-1 receptor antagonists should continue to be investigated as a potential therapeutic agent in CTEPH patients.

背景：内皮素-1 （ET-1）与肺动脉高压患者的肺动脉高压（PH）相关。ET-1在慢性血栓栓塞性肺动脉高压（CTEPH）中的作用尚未明确。因此，我们的目的是探索组织血栓栓塞物质作为ET-1来源的贡献。方法对40例mPAP≥50 mmHg的CTEPH患者（高mPAP组）和35例mPAP≤25 mmHg（低mPAP组）行肺动脉内膜切除术（PEA）的患者进行研究。新鲜冷冻PEA样品进行qRT-PCR，石蜡样品进行免疫组织化学染色进行ET-1定量。回顾术前CT肺血管造影，评估高mPAP组和低mPAP组肺部血管闭塞的总数。结果与低mPAP组相比，高mPAP组PEA标本中ET-1蛋白（p < 0.0001）和mRNA （p=0.0003）表达显著升高。我们发现ET-1蛋白和mRNA与肺阻力呈正相关。CT扫描显示，低mPAP组与高mPAP组肺血管树的整体阻塞没有差异（p=0.0929），但高mPAP组肺段血管（p=0.0362）和亚段血管（p=0.0029）被阻塞的数量明显增加。总的来说，女性患者在高mPAP组中ET-1的表达高于低mPAP组，并且亚段血管阻塞的数量也显著增加（p=0.0084）。结论ET-1从CTEPH患者的血栓栓塞物质中释放可能是导致ph的重要机制，因此，ET-1受体拮抗剂作为CTEPH患者的潜在治疗药物应继续进行研究。

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引用次数: 0

Letermovir: An enticing new CMV prophylaxis option with growing evidence in heart and lung transplantation Letermovir：一种诱人的新的巨细胞病毒预防选择，在心脏和肺移植中有越来越多的证据。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-25 DOI: 10.1016/j.healun.2025.09.015

Jack L. Skeggs MBBS , Bradley J. Gardiner MBBS, PhD

引用次数: 0

Superior cardiac protection in combined ex-situ perfusion of heart and liver 心肝联合离体灌注对心脏的保护作用。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-24 DOI: 10.1016/j.healun.2025.09.012

Sanaz Hatami MD, PhD , Joshua Hefler MD, PhD , Guilherme da Silva MD , Mitchell Wagner BSc , Mobashir Khan MD , Sayed Himmat MD , Shubham Shan MD , Xiuhua Wang PhD , Benjamin Adam MD, PhD , James Shapiro MD, PhD , Jayan Nagendran MD, PhD , Darren H. Freed MD, PhD, FRCSC

Background

Normothermic ex-situ heart perfusion has helped expand the heart donor pool however, it is not optimized yet. Experimental ex-situ organ perfusion incorporating cross-circulation with a live animal has achieved significantly longer safe ex-situ preservation times; however, the underlying mechanisms are not clear.

Methods

In this study, combined ex-situ heart-liver perfusion of porcine hearts was compared to ex-situ isolated heart perfusion. Discarded human donor hearts were also perfused ex-situ and cardiac function and metabolism was studied.

Results

The hearts perfused together with liver were preserved significantly better, with lower edema, preserved key nutrients, and lower oxidative stress, (comparable to in vivo samples). Human donor hearts subjected to ex-situ perfusion had similar function and oxidative patterns compared to isolated porcine hearts, suggesting these hearts are vulnerable to the same phenomena as porcine hearts.

Conclusions

Our findings suggest that efficient antioxidant and energy metabolite support is necessary for improving the functional preservation of the donor heart during ex-situ perfusion.

常温离地心脏灌注有助于扩大心脏供体库，但尚未优化。与活体动物交叉循环的实验性离体器官灌注实现了更长的安全离体保存时间；然而，其潜在机制尚不清楚。方法本研究将猪心脏-肝联合离体灌注与离体心脏灌注进行比较。丢弃的人供体心脏也进行了体外灌注，并研究了心脏功能和代谢。结果与活体样品相比，心脏与肝脏一起灌注后，心肌水肿减少，关键营养物质得以保存，氧化应激降低。与分离的猪心脏相比，经离体灌注的人类供体心脏具有相似的功能和氧化模式，这表明这些心脏容易受到与猪心脏相同的现象的影响。结论有效的抗氧化和能量代谢物支持是提高离体灌注时供心功能保存的必要条件。

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引用次数: 0

Modernization of the U.S. transplant system: Protecting donors and saving lives 1 donation at a time 美国移植系统的现代化：保护捐赠者，一次一次地挽救生命。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-24 DOI: 10.1016/j.healun.2025.09.004

Matthew Galen Hartwig MD , Dennis Mark Lyu MD

引用次数: 0

An evolving landscape: The many complexities of pediatric mechanical circulatory support 一个不断发展的景观：儿科机械循环支持的许多复杂性。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-23 DOI: 10.1016/j.healun.2025.09.008

Jondavid Menteer MD (Professor of Pediatrics (Clinician/Educator))

引用次数: 0

Fluoroless bedside implantation of the ProtekDuo cannula: Clinical experience at a tertiary care center ProtekDuo无氟床边植入套管：三级护理中心的临床经验。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-23 DOI: 10.1016/j.healun.2025.09.005

Pasquale Nardelli MD , Savino Altizio MD , Evgeny Fominskiy MD , Alessandro Ortalda MD , Luca Baldetti MD , Claudia Francescon PT , Silvia Ajello MD , Anna Mara Scandroglio MD

The ProtekDuo dual-lumen cannula allows percutaneous support in right ventricular failure with or without gas exchange impairments. However, positioning of the device is resource demanding. The usual approach requires a fluoroscopy–equipped operating room, possibly limiting its wider and timely adoption. We report our initial experience with bedside, fluoroless ProtekDuo implantation under transesophageal echocardiography (TEE) guidance in a tertiary care national referral center. Eight critically ill patients underwent bedside ProtekDuo placement for right ventricular dysfunction or acute respiratory distress syndrome with right ventricular failure. All procedures were completed successfully without procedural complications. Our findings demonstrate that bedside, TEE-guided, fluoroless ProtekDuo cannulation is feasible and safe, potentially expanding access to advanced mechanical circulatory support.

ProtekDuo双腔插管允许在有或没有气体交换损伤的右心室衰竭中进行经皮支持。然而，设备的定位是需要资源的。通常的方法需要配备透视镜的手术室，这可能限制了其更广泛和及时的采用。我们报告了我们在三级保健国家转诊中心经食管超声心动图（TEE）指导下床边无氟ProtekDuo植入的初步经验。8例危重患者因右室功能障碍或急性呼吸窘迫综合征合并右室衰竭接受床边ProtekDuo放置。所有手术均顺利完成，无手术并发症。我们的研究结果表明，床边、tee引导、无氟的ProtekDuo插管是可行和安全的，有可能扩大获得先进机械循环支持的途径。

引用次数: 0

DOAC or don’t? – Direct oral anticoagulants in LVADs 做还是不做？- lvad直接口服抗凝剂。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-23 DOI: 10.1016/j.healun.2025.09.014

Roxana Moayedifar MD PhD

引用次数: 0

The occasional heart transplant program 偶尔的心脏移植项目。

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-23 DOI: 10.1016/j.healun.2025.09.010

Aaron M. Williams MD, Ashish S. Shah MD

引用次数: 0

Information for Readers 读者资讯

IF 6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation

Pub Date : 2025-09-12 DOI: 10.1016/S1053-2498(25)02242-9

引用次数: 0

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