Pub Date : 2026-02-01Epub Date: 2026-01-16DOI: 10.1016/j.healun.2025.09.007
Jacob E. Møller , Norman Mangner , Vasileios Panoulas , Christian Hassager
{"title":"Letter to Carnicelli et al. outcomes with Impella CP in acute myocardial infarction vs heart failure cardiogenic shock","authors":"Jacob E. Møller , Norman Mangner , Vasileios Panoulas , Christian Hassager","doi":"10.1016/j.healun.2025.09.007","DOIUrl":"10.1016/j.healun.2025.09.007","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Page 312"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981960","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 : 2026-02-01Epub Date: 2025-09-12DOI: 10.1016/j.healun.2025.09.002
Nils Kremer MD , Felix Glocker MSc , Simon Schaefer , Patrick Janetzko , Athiththan Yogeswaran MD , Zvonimir Rako MD , Bruno Thal , Hans-Bernd Hopf MD , Werner Seeger MD , Hossein-Ardeschir Ghofrani MD , Paul M. Heerdt MD, PhD , Khodr Tello MD
Background
Analysis of pressure-volume (PV) loops from conductance catheterization is the gold standard for evaluating right ventricular (RV) function, but the complexity of conductance catheterization limits clinical implementation. This study validates a novel method for reconstructing RV PV loops from pressure waveforms acquired during routine right heart catheterization (RHC).
Methods
An algorithm was developed to estimate RV volume from pressure using the hydromotive source pressure model with external calibration. The method was validated against conductance catheterization in swine (preclinical cohort) and in patients with pulmonary hypertension (clinical cohort), and against 3-dimensional echocardiography in patients with routine RHC (feasibility cohort). Agreement was assessed using Bland-Altman analysis and correlation.
Results
In the preclinical cohort (n = 10, 22 recordings), pressure-derived stroke work (SW) demonstrated very good agreement with conductance values (bias −0.4%; percentage error 7.0%). End-diastolic volume (EDV) showed moderate agreement (bias 3.7%; percentage error 29.0%). In the clinical cohort (n = 44, 44 recordings), agreement was good for SW (bias −2.8%; percentage error 14.6%) and borderline for EDV (bias −5.5%; percentage error 35.3%). In the feasibility cohort (n = 29, 29 recordings), agreement was good for ejection fraction (EF) (bias 2.2%, percentage error 30.3%) and moderate for stroke volume (SV), EDV, end-systolic elastance (Ees), and arterial elastance. All parameters correlated strongly with reference values (Pearson r ≥ 0.79, p < 0.001).
Conclusion
This pressure-based method reconstructs RV PV loops from standard RHC data and reliably estimates SW, contractility, and afterload, supporting its integration into routine clinical workflows (tool freely available at https://pv-loop-generator.onrender.com).
{"title":"Method for generating right ventricular pressure-volume loops in routine practice","authors":"Nils Kremer MD , Felix Glocker MSc , Simon Schaefer , Patrick Janetzko , Athiththan Yogeswaran MD , Zvonimir Rako MD , Bruno Thal , Hans-Bernd Hopf MD , Werner Seeger MD , Hossein-Ardeschir Ghofrani MD , Paul M. Heerdt MD, PhD , Khodr Tello MD","doi":"10.1016/j.healun.2025.09.002","DOIUrl":"10.1016/j.healun.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Analysis of pressure-volume (PV) loops from conductance catheterization is the gold standard for evaluating right ventricular (RV) function, but the complexity of conductance catheterization limits clinical implementation. This study validates a novel method for reconstructing RV PV loops from pressure waveforms acquired during routine right heart catheterization (RHC).</div></div><div><h3>Methods</h3><div>An algorithm was developed to estimate RV volume from pressure using the hydromotive source pressure model with external calibration. The method was validated against conductance catheterization in swine (preclinical cohort) and in patients with pulmonary hypertension (clinical cohort), and against 3-dimensional echocardiography in patients with routine RHC (feasibility cohort). Agreement was assessed using Bland-Altman analysis and correlation.</div></div><div><h3>Results</h3><div>In the preclinical cohort (<em>n</em> = 10, 22 recordings), pressure-derived stroke work (SW) demonstrated very good agreement with conductance values (bias −0.4%; percentage error 7.0%). End-diastolic volume (EDV) showed moderate agreement (bias 3.7%; percentage error 29.0%). In the clinical cohort (<em>n</em> = 44, 44 recordings), agreement was good for SW (bias −2.8%; percentage error 14.6%) and borderline for EDV (bias −5.5%; percentage error 35.3%). In the feasibility cohort (<em>n</em> = 29, 29 recordings), agreement was good for ejection fraction (EF) (bias 2.2%, percentage error 30.3%) and moderate for stroke volume (SV), EDV, end-systolic elastance (Ees), and arterial elastance. All parameters correlated strongly with reference values (Pearson <em>r</em> ≥ 0.79, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>This pressure-based method reconstructs RV PV loops from standard RHC data and reliably estimates SW, contractility, and afterload, supporting its integration into routine clinical workflows (tool freely available at <span><span>https://pv-loop-generator.onrender.com</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 273-281"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059115","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 : 2026-02-01Epub Date: 2025-08-20DOI: 10.1016/j.healun.2025.08.010
Anthony P. Carnicelli MD , Shashank S. Sinha , Song Li MD , Borui Li , 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
Background
Impella CP (Abiomed, Danvers, MA) microaxial flow pumps are commonly used in acute myocardial infarction (AMI) and heart failure (HF) cardiogenic shock (CS). Contemporary data from large, unselected populations are needed to understand differences between these groups.
Methods
The Cardiogenic Shock Working Group registry enrolls patients with CS at 36 international sites. We analyzed patients with Impella CP enrolled from 2019-2024, categorized by CS etiology and mechanical support device exposure. Baseline characteristics, complications, and outcomes were compared. Outcomes included survival to discharge, native heart survival, and heart replacement therapy. Multivariable analysis was performed to identify predictors of in-hospital mortality and complications.
Results
A total of 1,486 patients with CS (57.9% AMI-CS, 34.9% HF-CS) and Impella CP were analyzed. Patients with HF-CS were younger (60 vs 64 years; p < 0.001) and more likely to have chronic kidney disease (26.4% vs 13.6; p < 0.001) than those with AMI-CS. Impella CP alone was used in 38.3%, CP+ extracorporeal membrane oxygenation in 23.1%, and CP + ≥2 other devices in 20.4%. Acute kidney injury was more common in HF-CS than AMI-CS (66.5% vs 59.7%, p = 0.03) and acute limb ischemia more common in AMI-CS than HF-CS (14.4% vs 11.0%; p = 0.05). Survival to discharge was 53.4% and was higher in HF-CS than AMI-CS (59.7% vs 49.8%; p < 0.001). Those with ≥2 other devices had the lowest survival (43.8%). Total device number was significantly associated with in-hospital mortality, limb ischemia, and bleeding.
Conclusions
Differences in baseline characteristics, device exposure, and hospital complications between patients with HF-CS and AMI-CS supported by Impella CP may influence outcomes.
目的impella CP （Abiomed, Danvers， MA）微轴流泵常用于急性心肌梗死（AMI）和心力衰竭（HF）心源性休克（CS）。要了解这些群体之间的差异，需要来自大量未选择人群的当代数据。方法心源性休克工作组（CSWG）登记了36个国际站点的CS患者。我们分析了2019-2024年入组的Impella CP患者，根据CS病因和机械支持装置暴露进行分类。比较基线特征、并发症和结果。结果包括存活至出院、原生心脏存活和心脏替代治疗。进行多变量分析以确定院内死亡率和并发症的预测因素。结果共分析1486例CS （AMI-CS占57.9%，HF-CS占34.9%）和Impella CP患者。与AMI-CS相比，HF-CS患者更年轻（60岁vs 64岁，p<0.001），更容易发生慢性肾脏疾病（26.4% vs 13.6%, p<0.001）。单独使用Impella CP的占38.3%，使用CP+ECMO的占23.1%，使用CP+≥2个其他装置的占20.4%。AMI-CS比AMI-CS更常见急性肾损伤（66.5%比59.7%,p=0.03）， AMI-CS比HF-CS更常见急性肢体缺血（14.4%比11.0%,p=0.05）。到出院的生存率为53.4%，HF-CS高于AMI-CS （59.7% vs 49.8%; p<0.001）。其他器械≥2种的患者生存率最低（43.8%）。总装置数量与住院死亡率、肢体缺血和出血显著相关。结论：Impella CP支持的HF-CS和AMI-CS患者在基线特征、器械暴露和医院并发症方面的差异可能会影响结果。
{"title":"Outcomes with Impella CP in acute myocardial infarction vs heart failure cardiogenic shock: Insights from the Cardiogenic Shock Working Group","authors":"Anthony P. Carnicelli MD , Shashank S. Sinha , Song Li MD , Borui Li , 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","doi":"10.1016/j.healun.2025.08.010","DOIUrl":"10.1016/j.healun.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Impella CP (Abiomed, Danvers, MA) microaxial flow pumps are commonly used in acute myocardial infarction (AMI) and heart failure (HF) cardiogenic shock (CS). Contemporary data from large, unselected populations are needed to understand differences between these groups.</div></div><div><h3>Methods</h3><div>The Cardiogenic Shock Working Group registry enrolls patients with CS at 36 international sites. We analyzed patients with Impella CP enrolled from 2019-2024, categorized by CS etiology and mechanical support device exposure. Baseline characteristics, complications, and outcomes were compared. Outcomes included survival to discharge, native heart survival, and heart replacement therapy. Multivariable analysis was performed to identify predictors of in-hospital mortality and complications.</div></div><div><h3>Results</h3><div>A total of 1,486 patients with CS (57.9% AMI-CS, 34.9% HF-CS) and Impella CP were analyzed. Patients with HF-CS were younger (60 vs 64 years; <em>p</em> < 0.001) and more likely to have chronic kidney disease (26.4% vs 13.6; <em>p</em> < 0.001) than those with AMI-CS. Impella CP alone was used in 38.3%, CP+ extracorporeal membrane oxygenation in 23.1%, and CP + ≥2 other devices in 20.4%. Acute kidney injury was more common in HF-CS than AMI-CS (66.5% vs 59.7%, <em>p</em> = 0.03) and acute limb ischemia more common in AMI-CS than HF-CS (14.4% vs 11.0%; <em>p</em> = 0.05). Survival to discharge was 53.4% and was higher in HF-CS than AMI-CS (59.7% vs 49.8%; <em>p</em> < 0.001). Those with ≥2 other devices had the lowest survival (43.8%). Total device number was significantly associated with in-hospital mortality, limb ischemia, and bleeding.</div></div><div><h3>Conclusions</h3><div>Differences in baseline characteristics, device exposure, and hospital complications between patients with HF-CS and AMI-CS supported by Impella CP may influence outcomes.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 262-272"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930161","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 : 2026-02-01Epub Date: 2025-11-13DOI: 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.
{"title":"Donation after circulatory determination of death heart transplantation using simplified direct procurement: Expanding access","authors":"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","doi":"10.1016/j.healun.2025.10.020","DOIUrl":"10.1016/j.healun.2025.10.020","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 199-203"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525111","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 : 2026-02-01Epub Date: 2025-10-24DOI: 10.1016/j.healun.2025.10.019
Khodr Tello MD , Marion Delcroix MD , Christine Pausch PhD , Doerte Huscher PhD , David Pittrow MD , H. Ardeschir Ghofrani MD , Roberto Badagliacca MD , Anton Vonk-Noordegraaf MD , Grzegorz Kopec MD , Michael Halank MD , Ralf Ewert MD , Hans Klose MD , Ekkehard Grünig MD , Andris Skride MD , Silvia Ulrich MD , Stefan Stadler MD , Laura Scelsi MD , Elena Pfeuffer-Jovic MD , Marius M. Hoeper MD , Karen M. Olsson MD
Parenteral prostacyclin analogues (PPA) are recommended for pulmonary arterial hypertension (PAH) patients at intermediate-high or high risk, yet supporting evidence remains limited. We retrospectively analyzed pretreated patients with idiopathic/heritable/drug-associated PAH (I/H/D-PAH), connective tissue disease-associated PAH (CTD-PAH), or congenital heart disease-associated PAH (CHD-PAH) from the COMPERA registry who received add-on PPA therapy. Among 495 patients, all pretreated with ≥1 PAH medication, add-on PPA treatment was associated with improvements in 6-minute walk distance, WHO functional class, and NT-proBNP across groups. However, mortality was high: Kaplan-Meier survival estimates at 5 years were 59% in I/H/D-PAH, 59% in CHD-PAH, and 31% in CTD-PAH. Independent predictors of mortality included older age, male sex, CTD, CHD, and intermediate-high or high risk at time of PPA initiation. These findings indicate short-term clinical improvements but high subsequent mortality with add-on PPA therapy in patients with PAH, particularly in those with CTD-PAH, underscoring the need for more effective therapies.
{"title":"Add-on therapy with parenteral prostacyclin analogues in patients with pulmonary arterial hypertension: Insights from the COMPERA registry","authors":"Khodr Tello MD , Marion Delcroix MD , Christine Pausch PhD , Doerte Huscher PhD , David Pittrow MD , H. Ardeschir Ghofrani MD , Roberto Badagliacca MD , Anton Vonk-Noordegraaf MD , Grzegorz Kopec MD , Michael Halank MD , Ralf Ewert MD , Hans Klose MD , Ekkehard Grünig MD , Andris Skride MD , Silvia Ulrich MD , Stefan Stadler MD , Laura Scelsi MD , Elena Pfeuffer-Jovic MD , Marius M. Hoeper MD , Karen M. Olsson MD","doi":"10.1016/j.healun.2025.10.019","DOIUrl":"10.1016/j.healun.2025.10.019","url":null,"abstract":"<div><div>Parenteral prostacyclin analogues (PPA) are recommended for pulmonary arterial hypertension (PAH) patients at intermediate-high or high risk, yet supporting evidence remains limited. We retrospectively analyzed pretreated patients with idiopathic/heritable/drug-associated PAH (I/H/D-PAH), connective tissue disease-associated PAH (CTD-PAH), or congenital heart disease-associated PAH (CHD-PAH) from the COMPERA registry who received add-on PPA therapy. Among 495 patients, all pretreated with ≥1 PAH medication, add-on PPA treatment was associated with improvements in 6-minute walk distance, WHO functional class, and NT-proBNP across groups. However, mortality was high: Kaplan-Meier survival estimates at 5 years were 59% in I/H/D-PAH, 59% in CHD-PAH, and 31% in CTD-PAH. Independent predictors of mortality included older age, male sex, CTD, CHD, and intermediate-high or high risk at time of PPA initiation. These findings indicate short-term clinical improvements but high subsequent mortality with add-on PPA therapy in patients with PAH, particularly in those with CTD-PAH, underscoring the need for more effective therapies.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 284-288"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382736","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 : 2026-02-01Epub Date: 2025-07-19DOI: 10.1016/j.healun.2025.07.010
Naoki Tadokoro MD PhD , Mansoo Cho MS , Taylor Nordan MD , Amy E. Hackmann MD , Sho Takemoto MD , Michael M. Givertz MD , Tanujit Dey PhD , Mandeep R. Mehra MD MSc , Akinobu Itoh MD PhD
Background
The incidence of simultaneous heart-kidney transplantation is increasing in the current era of transplantation. Whether delayed graft function of the kidney (requiring use of dialysis within the first week post-transplant) influences long-term patient survival remains underexplored.
Methods
This retrospective cohort study analyzed 1737 recipients of simultaneous heart-kidney transplants from the United Network for Organ Sharing database between October 2018 and October 2024. Patients were divided into groups based on the presence or absence of delayed kidney graft function. The primary outcome measure included patient survival at two years, and the principal secondary outcome was kidney allograft survival.
Results
Delayed graft function (DGF) occurred in 31.1% (n=540) of patients and was more common among those who were receiving extracorporeal membrane oxygenation at the time of transplantation. (10.6% vs. 4.3%, p<0.001) and a greater history of prior dialysis (65.4% vs. 37.0%, p<0.001). Patients in the DGF group had a lower two-year survival rate (72.0% vs. 89.7%, p<0.001), with infection (7.2% vs. 2.8%, p<0.001) and organ failure (kidney, liver, or multiple, 5.9% vs. 1.1%, p<0.001) being the primary causes of death. The adjusted multivariate Cox hazards model revealed that DGF increased patient mortality risk (adjusted hazard ratio:3.29, 95%CI: 2.51–4.33; p<0.001). Similarly, DGF was associated with kidney graft loss (adjusted hazard ratio:3.84; 95% CI: 3.01–4.90; p<0.001).
Conclusions
Among those undergoing simultaneous heart-kidney transplantation, DGF of the renal allograft is associated with an increase in late kidney graft failure and reduced long-term patient survival.
{"title":"Impact of delayed kidney graft function on long-term outcomes in simultaneous heart-kidney transplantation","authors":"Naoki Tadokoro MD PhD , Mansoo Cho MS , Taylor Nordan MD , Amy E. Hackmann MD , Sho Takemoto MD , Michael M. Givertz MD , Tanujit Dey PhD , Mandeep R. Mehra MD MSc , Akinobu Itoh MD PhD","doi":"10.1016/j.healun.2025.07.010","DOIUrl":"10.1016/j.healun.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of simultaneous heart-kidney transplantation is increasing in the current era of transplantation. Whether delayed graft function of the kidney (requiring use of dialysis within the first week post-transplant) influences long-term patient survival remains underexplored.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 1737 recipients of simultaneous heart-kidney transplants from the United Network for Organ Sharing database between October 2018 and October 2024. Patients were divided into groups based on the presence or absence of delayed kidney graft function. The primary outcome measure included patient survival at two years, and the principal secondary outcome was kidney allograft survival.</div></div><div><h3>Results</h3><div>Delayed graft function (DGF) occurred in 31.1% (n=540) of patients and was more common among those who were receiving extracorporeal membrane oxygenation at the time of transplantation. (10.6% vs. 4.3%, p<0.001) and a greater history of prior dialysis (65.4% vs. 37.0%, p<0.001). Patients in the DGF group had a lower two-year survival rate (72.0% vs. 89.7%, p<0.001), with infection (7.2% vs. 2.8%, p<0.001) and organ failure (kidney, liver, or multiple, 5.9% vs. 1.1%, p<0.001) being the primary causes of death. The adjusted multivariate Cox hazards model revealed that DGF increased patient mortality risk (adjusted hazard ratio:3.29, 95%CI: 2.51–4.33; p<0.001). Similarly, DGF was associated with kidney graft loss (adjusted hazard ratio:3.84; 95% CI: 3.01–4.90; p<0.001).</div></div><div><h3>Conclusions</h3><div>Among those undergoing simultaneous heart-kidney transplantation, DGF of the renal allograft is associated with an increase in late kidney graft failure and reduced long-term patient survival.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 215-224"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678097","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 : 2026-02-01Epub Date: 2025-06-04DOI: 10.1016/j.healun.2025.05.019
Katherine G. Phillips MD , Darren Stewart MS , Brian Wayda MD , Kelly Drozdowicz MD , Lena Trager MD , Alex Reyentovich MD , Marzia Leacche MD , Amit Alam MD , Nader Moazami MD
Background
Heart utilization from donation after circulatory death (DCD) donors remains highly variable across the United States, potentially resulting in missed transplantation opportunities. This study aimed to quantify the frequency of clinically viable, non-utilized DCD hearts and identify usage barriers.
Methods
We conducted a retrospective, national registry analysis of donors ≤55 years old who donated ≥1 organ, focusing primarily on DCDs. Donor characteristics, particularly age, warm ischemic time (WIT), and ejection fraction (EF), as well as reasons for non-recovery and offer refusal, were analyzed. Scientific Registry of Transplant Recipients (SRTRs) heart yield model was employed to identify non-utilized DCD hearts clinically comparable to transplanted DCD hearts.
Results
In 2023, 613 DCD hearts were transplanted, accounting for 13.5% of all heart transplants. Only 15.5% of DCD hearts from donors ≤55 years old were utilized. Marked variation in risk-adjusted DCD heart yield was observed between states, Organ Procurement Organizations (OPOs), and Regions. Donors of transplanted DCD hearts had a median age of 32, WIT 24 mins, and EF 63%. The yield model identified between 701 and 1,243 non-utilized DCD hearts with characteristics comparable to transplanted cases. Concerns about delayed progression to circulatory arrest after life support withdrawal was a key reason for non-utilization.
Conclusions
Despite wider acceptance of DCD heart transplantation, an increasing proportion of DCD hearts remain unused despite favorable characteristics. Concerns related to delayed progression to circulatory arrest are a significant barrier to heart utilization. Addressing geographic variability and improving predictive models for donor viability could double DCD heart utilization and expand heart transplantation volume by approximately 700-1,200 (15%-27%) annually.
{"title":"Barriers and opportunities in donation after circulatory death heart transplantation","authors":"Katherine G. Phillips MD , Darren Stewart MS , Brian Wayda MD , Kelly Drozdowicz MD , Lena Trager MD , Alex Reyentovich MD , Marzia Leacche MD , Amit Alam MD , Nader Moazami MD","doi":"10.1016/j.healun.2025.05.019","DOIUrl":"10.1016/j.healun.2025.05.019","url":null,"abstract":"<div><h3>Background</h3><div>Heart utilization from donation after circulatory death (DCD) donors remains highly variable across the United States, potentially resulting in missed transplantation opportunities. This study aimed to quantify the frequency of clinically viable, non-utilized DCD hearts and identify usage barriers.</div></div><div><h3>Methods</h3><div><span>We conducted a retrospective, national registry analysis of donors ≤55 years old who donated ≥1 organ, focusing primarily on DCDs. Donor characteristics, particularly age, warm ischemic time (WIT), and </span>ejection fraction<span> (EF), as well as reasons for non-recovery and offer refusal, were analyzed. Scientific Registry of Transplant Recipients (SRTRs) heart yield model was employed to identify non-utilized DCD hearts clinically comparable to transplanted DCD hearts.</span></div></div><div><h3>Results</h3><div><span>In 2023, 613 DCD hearts were transplanted, accounting for 13.5% of all heart transplants. Only 15.5% of DCD hearts from donors ≤55 years old were utilized. Marked variation in risk-adjusted DCD heart yield was observed between states, </span>Organ Procurement Organizations (OPOs), and Regions. Donors of transplanted DCD hearts had a median age of 32, WIT 24 mins, and EF 63%. The yield model identified between 701 and 1,243 non-utilized DCD hearts with characteristics comparable to transplanted cases. Concerns about delayed progression to circulatory arrest after life support withdrawal was a key reason for non-utilization.</div></div><div><h3>Conclusions</h3><div>Despite wider acceptance of DCD heart transplantation<span>, an increasing proportion of DCD hearts remain unused despite favorable characteristics. Concerns related to delayed progression to circulatory arrest are a significant barrier to heart utilization. Addressing geographic variability and improving predictive models for donor viability could double DCD heart utilization and expand heart transplantation volume by approximately 700-1,200 (15%-27%) annually.</span></div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 184-195"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248253","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 : 2026-02-01Epub Date: 2025-11-13DOI: 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
{"title":"Author’s response to Moeller et al.","authors":"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","doi":"10.1016/j.healun.2025.10.011","DOIUrl":"10.1016/j.healun.2025.10.011","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 313-314"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525121","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 : 2026-02-01Epub Date: 2026-01-08DOI: 10.1016/j.healun.2025.10.028
Andrew M. Courtwright MD, PhD , John A. Mackintosh , Jonathan K. Alder , Christine Kim Garcia , Antoine Froidure , Erin Lowery , Don Hayes Jr. , Shah Pali , Quentin Philippot , Raphael Borie , John R. Greenland , Hannah Mannem , Mark E. Snyder , Merel Hellemons , Laurie D. Snyder , John McDyer
Motivated by growing evidence that the presence of critically shortened telomeres influences interstitial lung disease (ILD) trajectories and is associated with extrapulmonary conditions relevant to lung transplant candidacy and post-transplant complications, this Consensus Statement aims to address gaps in the evaluation and management of patients with short telomere syndrome (STS). These considerations reflect the work of an international Writing Committee with expertise in STS and are grounded in current literature and expert consensus. The need for this document arises from the recognition that STS is an underdiagnosed contributor to ILD, and that its presence introduces complexities that require dedicated, multidisciplinary attention in the transplant setting.
{"title":"ISHLT Consensus Statement on Short Telomere Syndrome and Lung Transplantation","authors":"Andrew M. Courtwright MD, PhD , John A. Mackintosh , Jonathan K. Alder , Christine Kim Garcia , Antoine Froidure , Erin Lowery , Don Hayes Jr. , Shah Pali , Quentin Philippot , Raphael Borie , John R. Greenland , Hannah Mannem , Mark E. Snyder , Merel Hellemons , Laurie D. Snyder , John McDyer","doi":"10.1016/j.healun.2025.10.028","DOIUrl":"10.1016/j.healun.2025.10.028","url":null,"abstract":"<div><div>Motivated by growing evidence that the presence of critically shortened telomeres influences interstitial lung disease (ILD) trajectories and is associated with extrapulmonary conditions relevant to lung transplant candidacy and post-transplant complications, this Consensus Statement aims to address gaps in the evaluation and management of patients with short telomere syndrome (STS). These considerations reflect the work of an international Writing Committee with expertise in STS and are grounded in current literature and expert consensus. The need for this document arises from the recognition that STS is an underdiagnosed contributor to ILD, and that its presence introduces complexities that require dedicated, multidisciplinary attention in the transplant setting.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages e83-e103"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933618","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 : 2026-02-01Epub Date: 2025-05-30DOI: 10.1016/j.healun.2025.05.014
Abby McCaig , Andrew Sage , Shaf Keshavjee , Mingyao Liu
Lung transplantation remains the only curative treatment option for patients with end-stage lung disease, yet limited donor lung availability and utilization remains a significant obstacle. The ex vivo lung perfusion (EVLP) system allows for the extension of the donor assessment, providing the opportunity to perform advanced assessment on the isolated donor lung under near-physiological conditions. Measuring biomarkers in EVLP perfusate can provide valuable information on the condition of the donor lungs. This review examines biomarkers measured in EVLP perfusate and their ability to predict donor lung utilization and outcomes. Biomarkers in this review can be classified as cytokines, cell death, and endothelial-related molecules, showing potential for clinical application. Some of these biomarkers have also been used to monitor the effects of various therapeutics for donor lung repair or for modification of the EVLP technique. Yet, many limitations persist throughout these studies, which provides the opportunity for extensive future research. The integration of biomarkers with other data collected during EVLP through machine learning and artificial intelligence will lead to automated organ assessment to improve lung transplantation.
{"title":"Biomarkers for human donor lung assessment during ex vivo lung perfusion","authors":"Abby McCaig , Andrew Sage , Shaf Keshavjee , Mingyao Liu","doi":"10.1016/j.healun.2025.05.014","DOIUrl":"10.1016/j.healun.2025.05.014","url":null,"abstract":"<div><div>Lung transplantation remains the only curative treatment option for patients with end-stage lung disease, yet limited donor lung availability and utilization remains a significant obstacle. The ex vivo lung perfusion (EVLP) system allows for the extension of the donor assessment, providing the opportunity to perform advanced assessment on the isolated donor lung under near-physiological conditions. Measuring biomarkers in EVLP perfusate can provide valuable information on the condition of the donor lungs. This review examines biomarkers measured in EVLP perfusate and their ability to predict donor lung utilization and outcomes. Biomarkers in this review can be classified as cytokines, cell death, and endothelial-related molecules, showing potential for clinical application. Some of these biomarkers have also been used to monitor the effects of various therapeutics for donor lung repair or for modification of the EVLP technique. Yet, many limitations persist throughout these studies, which provides the opportunity for extensive future research. The integration of biomarkers with other data collected during EVLP through machine learning and artificial intelligence will lead to automated organ assessment to improve lung transplantation.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 300-308"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199353","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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