Pub Date : 2024-08-23DOI: 10.1016/j.healun.2024.08.014
Dag Edström MD , Anna Niroomand MD, PhD , Martin Stenlo MD, PhD , Ellen Broberg MD, PhD , Gabriel Hirdman MD , Haider Ghaidan MD, PhD , Snejana Hyllén MD, PhD , Leif Pierre PhD , Franziska Olm PhD , Sandra Lindstedt MD, PhD
Background
Lung transplantation is hindered by low donor lung utilization rates. Infectious complications are reasons to decline donor grafts due to fear of post-transplant primary graft dysfunction. Mesenchymal stem cells are a promising therapy currently investigated in treating lung injury. Full-term amniotic fluid-derived lung-specific mesenchymal stem cell treatment may regenerate damaged lungs. These cells have previously demonstrated inflammatory mediation in other respiratory diseases, and we hypothesized that treatment would improve donor lung quality and postoperative outcomes.
Methods
In a transplantation model, donor pigs were stratified to either the treated or the nontreated group. Acute respiratory distress syndrome was induced in donor pigs and harvested lungs were placed on ex vivo lung perfusion (EVLP) before transplantation. Treatment consisted of 3 doses of 2 × 106 cells/kg: one during EVLP and 2 after transplantation. Donors and recipients were assessed on clinically relevant parameters and recipients were followed for 3 days before evaluation for primary graft dysfunction (PGD).
Results
Repeated injection of the cell treatment showed reductions in inflammation seen through lowered immune cell counts, reduced histology signs of inflammation, and decreased cytokines in the plasma and bronchoalveolar lavage fluid. Treated recipients showed improved pulmonary function, including increased PaO2/FiO2 ratios and reduced incidence of PGD.
Conclusions
Repeated injection of lung-specific cell treatment during EVLP and post transplant was associated with improved function of previously damaged lungs. Cell treatment may be considered as a potential therapy to increase the number of lungs available for transplantation and the improvement of postoperative outcomes.
{"title":"Amniotic fluid-derived mesenchymal stem cells reduce inflammation and improve lung function following transplantation in a porcine model","authors":"Dag Edström MD , Anna Niroomand MD, PhD , Martin Stenlo MD, PhD , Ellen Broberg MD, PhD , Gabriel Hirdman MD , Haider Ghaidan MD, PhD , Snejana Hyllén MD, PhD , Leif Pierre PhD , Franziska Olm PhD , Sandra Lindstedt MD, PhD","doi":"10.1016/j.healun.2024.08.014","DOIUrl":"10.1016/j.healun.2024.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation is hindered by low donor lung utilization rates. Infectious complications are reasons to decline donor grafts due to fear of post-transplant primary graft dysfunction. Mesenchymal stem cells are a promising therapy currently investigated in treating lung injury. Full-term amniotic fluid-derived lung-specific mesenchymal stem cell treatment may regenerate damaged lungs. These cells have previously demonstrated inflammatory mediation in other respiratory diseases, and we hypothesized that treatment would improve donor lung quality and postoperative outcomes.</div></div><div><h3>Methods</h3><div>In a transplantation model, donor pigs were stratified to either the treated or the nontreated group. Acute respiratory distress syndrome was induced in donor pigs and harvested lungs were placed on ex vivo lung perfusion (EVLP) before transplantation. Treatment consisted of 3 doses of 2 × 10<sup>6</sup> cells/kg: one during EVLP and 2 after transplantation. Donors and recipients were assessed on clinically relevant parameters and recipients were followed for 3 days before evaluation for primary graft dysfunction (PGD).</div></div><div><h3>Results</h3><div>Repeated injection of the cell treatment showed reductions in inflammation seen through lowered immune cell counts, reduced histology signs of inflammation, and decreased cytokines in the plasma and bronchoalveolar lavage fluid. Treated recipients showed improved pulmonary function, including increased PaO<sub>2</sub>/FiO<sub>2</sub> ratios and reduced incidence of PGD.</div></div><div><h3>Conclusions</h3><div>Repeated injection of lung-specific cell treatment during EVLP and post transplant was associated with improved function of previously damaged lungs. Cell treatment may be considered as a potential therapy to increase the number of lungs available for transplantation and the improvement of postoperative outcomes.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 12","pages":"Pages 2018-2030"},"PeriodicalIF":6.4,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1016/j.healun.2024.08.011
Michael J. Simmonds PhD , Bente Thamsen PhD , Salim E. Olia PhD , Antony P. McNamee PhD , Marcus Granegger PhD , Hendrik Wurm Dr.-Ing. , Keshava Rajagopal MD, PhD , David C. McGiffin MBBS, DMedHS
Mechanical circulatory support devices have profoundly transformed the management of severe cardiothoracic disorders. While heart transplantation is the gold standard therapy for end-stage heart disease, long-term mechanical support devices are a viable alternative for those ineligible and/or those awaiting organ availability. Major technological advancements were made over first 5 decades of development, resulting in improved durability and survival with reduced adverse events. However, gains have tapered recently for various complications (e.g., internal bleeding, multisystem organ failure), which collectively represent a significant proportion of disability and/or mortality. Further, in light of mature ventricular assist devices failing during clinical trials or even after clinical approval (class I withdrawals), it is timely to consider: Are our preclinical assessment protocols vital in the design and development of mechanical circulatory support devices, providing a realistic and reliable profile of future clinical performance? This commentary explores this question and analyses development pathways through the lens of the various disciplines involved in the preclinical assessment of mechanical circulatory support technologies: Limitations in approaches to benchtop blood testing, computational design and simulation, and animal testing are discussed as likely contributors to some of the common hemocompatibility-related adverse events (HRAEs). While it is acknowledged that some shortcomings are pragmatic in nature, possible solutions are presented that will only be realized through truly transdisciplinary and open approaches that challenge the current nature of medical device development. We suggest that these can and must be overcome to diminish HRAEs and will potentially demarcate the fourth generation of cardiac assist devices.
{"title":"Will blood-informed design signal the fourth generation of cardiac assist devices?","authors":"Michael J. Simmonds PhD , Bente Thamsen PhD , Salim E. Olia PhD , Antony P. McNamee PhD , Marcus Granegger PhD , Hendrik Wurm Dr.-Ing. , Keshava Rajagopal MD, PhD , David C. McGiffin MBBS, DMedHS","doi":"10.1016/j.healun.2024.08.011","DOIUrl":"10.1016/j.healun.2024.08.011","url":null,"abstract":"<div><div>Mechanical circulatory support devices have profoundly transformed the management of severe cardiothoracic disorders. While heart transplantation is the gold standard therapy for end-stage heart disease, long-term mechanical support devices are a viable alternative for those ineligible and/or those awaiting organ availability. Major technological advancements were made over first 5 decades of development, resulting in improved durability and survival with reduced adverse events. However, gains have tapered recently for various complications (e.g., internal bleeding, multisystem organ failure), which collectively represent a significant proportion of disability and/or mortality. Further, in light of mature ventricular assist devices failing during clinical trials or even after clinical approval (class I withdrawals), it is timely to consider: Are our preclinical assessment protocols vital in the design and development of mechanical circulatory support devices, providing a realistic and reliable profile of future clinical performance? This commentary explores this question and analyses development pathways through the lens of the various disciplines involved in the preclinical assessment of mechanical circulatory support technologies: Limitations in approaches to benchtop blood testing, computational design and simulation, and animal testing are discussed as likely contributors to some of the common hemocompatibility-related adverse events (HRAEs). While it is acknowledged that some shortcomings are pragmatic in nature, possible solutions are presented that will only be realized through truly transdisciplinary and open approaches that challenge the current nature of medical device development. We suggest that these <em>can</em> and must be overcome to diminish HRAEs and will potentially demarcate the fourth generation of cardiac assist devices.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 11","pages":"Pages 1767-1770"},"PeriodicalIF":6.4,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055738","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 : 2024-08-22DOI: 10.1016/j.healun.2024.08.013
Savitri Fedson MD, MA , Kelly Bryce PhD , Andrew Courtwright MD, PhD , Jon Dark MBBS , Tom Egan MD, MSc , Are Martin Holm MD, PhD , Olivia Kates MD, MA , Jacob Lavee MD , Anne Olland MD , The Ethics Committee of the ISHLT
{"title":"The relevance of the ethics statement of the ISHLT","authors":"Savitri Fedson MD, MA , Kelly Bryce PhD , Andrew Courtwright MD, PhD , Jon Dark MBBS , Tom Egan MD, MSc , Are Martin Holm MD, PhD , Olivia Kates MD, MA , Jacob Lavee MD , Anne Olland MD , The Ethics Committee of the ISHLT","doi":"10.1016/j.healun.2024.08.013","DOIUrl":"10.1016/j.healun.2024.08.013","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 11","pages":"Pages 1816-1817"},"PeriodicalIF":6.4,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055739","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 : 2024-08-17DOI: 10.1016/j.healun.2024.08.004
Maria T. Gamero MD,, Yevgeniy Brailovsky DO, MSc,, Howard J. Eisen MD
{"title":"Going the distance: Long-term follow-up of the randomized, prospective Scandinavian heart transplant everolimus de novo study with early calcineurin inhibitors avoidance (SCHEDULE) trial","authors":"Maria T. Gamero MD,, Yevgeniy Brailovsky DO, MSc,, Howard J. Eisen MD","doi":"10.1016/j.healun.2024.08.004","DOIUrl":"10.1016/j.healun.2024.08.004","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 12","pages":"Pages 1960-1962"},"PeriodicalIF":6.4,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004324","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}
Exposure to air pollution post-lung transplant has been shown to decrease graft and patient survival. This study examines the impact of air pollution exposure in the first 3 months post-transplant on baseline (i.e., highest) forced expiratory volume in 1 second (FEV1) achieved and development of chronic lung allograft dysfunction (CLAD).
Methods
Double-lung transplant recipients (n = 82) were prospectively enrolled for comprehensive indoor and personal environmental monitoring at 6- and 12-week post transplant and followed for >4 years. Associations between clinical and exposure variables were investigated using an exposomics approach followed by analysis with a Cox proportional hazards model. Multivariable analyses were used to examine the impact of air pollution on baseline % predicted FEV1 (defined as the average of the 2 highest values post transplant) and risk of CLAD.
Results
Multivariable analysis revealed a significant inverse relationship between personal black carbon (BC) levels and baseline % FEV1. The multivariable model indicated that patients with higher-than-median exposure to BC (>350 ng/m3) attained a baseline % FEV1 that was 8.8% lower than those with lower-than-median BC exposure (p = 0.019). Cox proportional hazards model analysis revealed that patients with high personal BC exposure had a 2.4 times higher hazard risk for CLAD than patients with low BC exposure (p = 0.045).
Conclusions
Higher personal BC levels during the first 3 months post-transplant decrease baseline FEV1 and double the risk of CLAD. Strategies to reduce BC exposure early following a lung transplant may help improve lung function and long-term outcomes.
{"title":"Pollution exposure in the first 3 months post transplant is associated with lower baseline FEV1 and higher CLAD risk","authors":"Denny Choi MPH , Michelle North PhD , Musawir Ahmed MD , Natalia Belousova MD , Anastasiia Vasileva MD, MSc , John Matelski Msc , Lianne G. Singer MD , Joyce K.Y. Wu HBSc , Cheol-Heon Jeong PhD , Greg Evans PhD , Chung-Wai Chow MD, PhD, FRCPC","doi":"10.1016/j.healun.2024.08.003","DOIUrl":"10.1016/j.healun.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Exposure to air pollution post-lung transplant has been shown to decrease graft and patient survival. This study examines the impact of air pollution exposure in the first 3 months post-transplant on baseline (i.e., highest) forced expiratory volume in 1 second (FEV<sub>1</sub>) achieved and development of chronic lung allograft dysfunction (CLAD).</div></div><div><h3>Methods</h3><div>Double-lung transplant recipients (<em>n</em> = 82) were prospectively enrolled for comprehensive indoor and personal environmental monitoring at 6- and 12-week post transplant and followed for >4 years. Associations between clinical and exposure variables were investigated using an exposomics approach followed by analysis with a Cox proportional hazards model. Multivariable analyses were used to examine the impact of air pollution on baseline % predicted FEV<sub>1</sub> (defined as the average of the 2 highest values post transplant) and risk of CLAD.</div></div><div><h3>Results</h3><div>Multivariable analysis revealed a significant inverse relationship between personal black carbon (BC) levels and baseline % FEV<sub>1</sub>. The multivariable model indicated that patients with higher-than-median exposure to BC (>350 ng/m<sup>3</sup>) attained a baseline % FEV<sub>1</sub> that was 8.8% lower than those with lower-than-median BC exposure (<em>p</em> = 0.019). Cox proportional hazards model analysis revealed that patients with high personal BC exposure had a 2.4 times higher hazard risk for CLAD than patients with low BC exposure (<em>p</em> = 0.045).</div></div><div><h3>Conclusions</h3><div>Higher personal BC levels during the first 3 months post-transplant decrease baseline FEV<sub>1</sub> and double the risk of CLAD. Strategies to reduce BC exposure early following a lung transplant may help improve lung function and long-term outcomes.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 12","pages":"Pages 1987-1997"},"PeriodicalIF":6.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1016/j.healun.2024.08.006
Jennifer A. Cowger MD, MS , Ezequiel Molina MD , Luqin Deng PhD , Manreet Kanwar MD , Palak Shah MD, MS , Rebecca Cogswell MD, MS , Igor Gosev MD, PhD , Ryan S. Cantor PhD , Todd F. Dardas MD, MS , James K. Kirklin MD , Joseph G. Rogers MD , Joseph C. Cleveland MD , Kristin E. Sandau PhD, RN , Colleen K. McIlvennan PhD , David Kaczorowski MD , Jerry D. Estep MD , Francis D. Pagani MD, PhD
Background
Patients have substantial variability in perioperative outcomes after left ventricular assist device (LVAD) implant. A perioperative multidimensional tool integrating mortality, adverse events (AEs), and patient-reported outcomes to assist in quality improvement initiatives is needed.
Methods
Patients undergoing HeartMate 3 LVAD implant (January 1, 2017 to January 31, 2024) in the Society of Thoracic Surgeons’ Intermacs registry were studied. Cox proportional hazard multivariable analyses incorporating AEs as time-varying covariates for mortality out to 180 days was used to generate the INtermacs Short term composITE quality score (INSITE score derivation), reflecting the adjusted hazard ratio (HR) for mortality contributed by each AE, applying the global ranking methodology. In those alive and on support at 6 months, multivariable logistic regression (odds ratio) was used to examine the impact of AEs on health-related quality of life (QOL) at 180 days, captured through the INSITE-QOL score. Failure to achieve ≥1 point increase in visual analog scale from baseline was the event.
Results
Of 13,148 patients, 4,389 (33.4%) suffered at least 1 AE or death through 180 days. Stroke (survival: HR 13.1; QOL: HR 1.7), dialysis (survival: HR 31.4; QOL: HR 4.2), prolonged respiratory failure (survival: HR 5.7; QOL: HR 2.3), reoperation (survival: HR 3.4; QOL: HR 1.6), and right heart failure (survival: 5.0; QOL: HR 1.4), contributed to both mortality and failure to improve QOL at 180 days (all p < 0.05). The median INSITE and INSITE-QOL scores were 0.0 [0.0, 1.6] and 0.0 [0.0, 0.0], respectively. At 9.4% (n = 17) of centers, a high INSITE score (≥13) was present in 15% of patients, while the top 25% of centers had perfect INSITE-QOL scores in at least 75% of patients.
Conclusions
AEs after LVAD confer differential impact on mortality and QOL, enabling the development of global rank outcome scores. Given the high mortality hazard conferred by 180-day AEs, center-specific quality interventions aimed at reducing early complications provide the greatest opportunity to improve long-term survival and QOL.
{"title":"Defining optimal left ventricular assist device short-term outcomes may provide insight into programmatic quality assessment","authors":"Jennifer A. Cowger MD, MS , Ezequiel Molina MD , Luqin Deng PhD , Manreet Kanwar MD , Palak Shah MD, MS , Rebecca Cogswell MD, MS , Igor Gosev MD, PhD , Ryan S. Cantor PhD , Todd F. Dardas MD, MS , James K. Kirklin MD , Joseph G. Rogers MD , Joseph C. Cleveland MD , Kristin E. Sandau PhD, RN , Colleen K. McIlvennan PhD , David Kaczorowski MD , Jerry D. Estep MD , Francis D. Pagani MD, PhD","doi":"10.1016/j.healun.2024.08.006","DOIUrl":"10.1016/j.healun.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients have substantial variability in perioperative outcomes after left ventricular assist device (LVAD) implant. A perioperative multidimensional tool integrating mortality, adverse events (AEs), and patient-reported outcomes to assist in quality improvement initiatives is needed.</div></div><div><h3>Methods</h3><div>Patients undergoing HeartMate 3 LVAD implant (January 1, 2017 to January 31, 2024) in the Society of Thoracic Surgeons’ Intermacs registry were studied. Cox proportional hazard multivariable analyses incorporating AEs as time-varying covariates for mortality out to 180 days was used to generate the INtermacs Short term composITE quality score (INSITE score derivation), reflecting the adjusted hazard ratio (HR) for mortality contributed by each AE, applying the global ranking methodology. In those alive and on support at 6 months, multivariable logistic regression (odds ratio) was used to examine the impact of AEs on health-related quality of life (QOL) at 180 days, captured through the INSITE-QOL score. Failure to achieve ≥1 point increase in visual analog scale from baseline was the event.</div></div><div><h3>Results</h3><div>Of 13,148 patients, 4,389 (33.4%) suffered at least 1 AE or death through 180 days. Stroke (survival: HR 13.1; QOL: HR 1.7), dialysis (survival: HR 31.4; QOL: HR 4.2), prolonged respiratory failure (survival: HR 5.7; QOL: HR 2.3), reoperation (survival: HR 3.4; QOL: HR 1.6), and right heart failure (survival: 5.0; QOL: HR 1.4), contributed to both mortality and failure to improve QOL at 180 days (all <em>p</em> < 0.05). The median INSITE and INSITE-QOL scores were 0.0 [0.0, 1.6] and 0.0 [0.0, 0.0], respectively. At 9.4% (<em>n</em> = 17) of centers, a high INSITE score (≥13) was present in 15% of patients, while the top 25% of centers had perfect INSITE-QOL scores in at least 75% of patients.</div></div><div><h3>Conclusions</h3><div>AEs after LVAD confer differential impact on mortality and QOL, enabling the development of global rank outcome scores. Given the high mortality hazard conferred by 180-day AEs, center-specific quality interventions aimed at reducing early complications provide the greatest opportunity to improve long-term survival and QOL.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 11","pages":"Pages 1777-1787"},"PeriodicalIF":6.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982441","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 : 2024-08-10DOI: 10.1016/j.healun.2024.08.002
Isabelle Etienne MD , Delphine Kemlin MD , Nicolas Gemander MD , Véronique Olislagers MSc , Alexandra Waegemans , Emilie Dhondt MSc , Leo Heyndrickx MSc , Stéphanie Depickère MSc, PhD , Alexia Charles MSc, PhD , Maria Goossens MD, PhD , Leen Vandermosten MSc, PhD , Isabelle Desombere MSc, PhD , Kevin K. Ariën MSc, PhD , Pieter Pannus PhD , Christiane Knoop MD, PhD , Arnaud Marchant MD, PhD
Lung transplant recipients (LTRs) are susceptible to severe Coronavirus Disease 2019 (COVID-19) and had lower immune responses to primary severe acute respiratory syndrome-related to coronavirus 2 (SARS-CoV-2) vaccination as compared to the general population and to other solid organ transplant recipients. As immunity induced by booster vaccination and natural infection has increased since the beginning of the pandemic in the general population, immunity acquired by LTRs is not well documented. Humoral and cellular immunity to SARS-CoV-2 was monitored in February and May 2023 in 30 LTRs and compared to that of health care workers (HCWs) and nursing home residents (NHRs). LTRs had significantly lower levels of SARS-CoV-2 binding and neutralizing antibodies and lower interferon-gamma responses to Wuhan, Delta, and XBB1.5 variants as compared to HCWs and NHRs. Humoral immunity decreased between the 2 visits, whereas cellular immunity remained more stable. The persistent defect in SARS-CoV-2 immunity in LTRs should encourage continued monitoring and preventive measures for this vulnerable population.
{"title":"Persistent defect in SARS-CoV-2 humoral and cellular immunity in lung transplant recipients","authors":"Isabelle Etienne MD , Delphine Kemlin MD , Nicolas Gemander MD , Véronique Olislagers MSc , Alexandra Waegemans , Emilie Dhondt MSc , Leo Heyndrickx MSc , Stéphanie Depickère MSc, PhD , Alexia Charles MSc, PhD , Maria Goossens MD, PhD , Leen Vandermosten MSc, PhD , Isabelle Desombere MSc, PhD , Kevin K. Ariën MSc, PhD , Pieter Pannus PhD , Christiane Knoop MD, PhD , Arnaud Marchant MD, PhD","doi":"10.1016/j.healun.2024.08.002","DOIUrl":"10.1016/j.healun.2024.08.002","url":null,"abstract":"<div><div>Lung transplant recipients (LTRs) are susceptible to severe Coronavirus Disease 2019 (COVID-19) and had lower immune responses to primary severe acute respiratory syndrome-related to coronavirus 2 (SARS-CoV-2) vaccination as compared to the general population and to other solid organ transplant recipients. As immunity induced by booster vaccination and natural infection has increased since the beginning of the pandemic in the general population, immunity acquired by LTRs is not well documented. Humoral and cellular immunity to SARS-CoV-2 was monitored in February and May 2023 in 30 LTRs and compared to that of health care workers (HCWs) and nursing home residents (NHRs). LTRs had significantly lower levels of SARS-CoV-2 binding and neutralizing antibodies and lower interferon-gamma responses to Wuhan, Delta, and XBB1.5 variants as compared to HCWs and NHRs. Humoral immunity decreased between the 2 visits, whereas cellular immunity remained more stable. The persistent defect in SARS-CoV-2 immunity in LTRs should encourage continued monitoring and preventive measures for this vulnerable population.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 11","pages":"Pages 1857-1860"},"PeriodicalIF":6.4,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1016/j.healun.2024.08.005
Jennifer Conway MD , Tara Pidborochynski MSc , Diana Ly BN , Leah Mowat BN , Darren H. Freed MD, PhD , Izak De Villiers Jonker MD , Mohammed Al-Aklabi MD , Paula Holinski MD , Vijay Anand MD , Holger Buchholz MD
For smaller pediatric patients on ventricular assist devices, the Berlin Heart EXCOR remains the main form of durable support. It requires a connection to the external IKUS, which has limited portability and battery life. The new EXCOR Active mobile driving unit has a battery life of up to 13 hours. We describe the first North American experience with the EXCOR Active in pediatric patients with a Berlin Heart device. A retrospective chart review was undertaken. Between October 2022 and March 2024, 7 patients were on a Berlin Heart and supported with the EXCOR Active. All patients were initially supported with the IKUS with a median time to transition to the EXCOR Active of 12.0 days (interquartile range [IQR] 9.5, 18.5) and a median time of support with the EXCOR Active of 65.0 days (IQR, 32.0, 81.0). The EXCOR Active posed no significant safety issues, and minimal operating issues were noted. Following the transition from IKUS to the EXCOR Active, there was increased patient and caregiver mobility throughout the hospital. Use of the EXCOR Active has the potential to improve the quality of life in pediatric patients waiting for heart transplantation.
对于使用心室辅助装置（VAD）的较小儿童患者，柏林心脏 EXCOR® 仍是主要的持久支持方式。它需要与外部 IKUS 连接，其便携性和电池寿命有限。新型 EXCOR® Active 移动驱动装置的电池寿命长达 13 小时。我们介绍了 EXCOR® Active 在北美首次用于使用柏林之心设备的儿童患者的经验。我们进行了回顾性病历审查。在 2022 年 10 月至 2024 年 3 月期间，有七名患者使用了柏林之心，并得到了 EXCOR® Active 的支持。所有患者最初都使用 IKUS 支持，过渡到 EXCOR® Active 的中位时间为 12.0 天（IQR 9.5，18.5），使用 EXCOR® Active 支持的中位时间为 65.0 天（IQR 32.0，81.0）。EXCOR® Active 不存在重大安全问题，操作问题也极少。从 IKUS 过渡到 EXCOR® Active 后，病人和护理人员在医院内的移动性增加了。使用 EXCOR® Active 有可能提高等待心脏移植的儿童患者的生活质量。
{"title":"First North American experience with the Berlin Heart EXCOR Active driver","authors":"Jennifer Conway MD , Tara Pidborochynski MSc , Diana Ly BN , Leah Mowat BN , Darren H. Freed MD, PhD , Izak De Villiers Jonker MD , Mohammed Al-Aklabi MD , Paula Holinski MD , Vijay Anand MD , Holger Buchholz MD","doi":"10.1016/j.healun.2024.08.005","DOIUrl":"10.1016/j.healun.2024.08.005","url":null,"abstract":"<div><div>For smaller pediatric patients on ventricular assist devices, the Berlin Heart EXCOR remains the main form of durable support. It requires a connection to the external IKUS, which has limited portability and battery life. The new EXCOR Active mobile driving unit has a battery life of up to 13 hours. We describe the first North American experience with the EXCOR Active in pediatric patients with a Berlin Heart device. A retrospective chart review was undertaken. Between October 2022 and March 2024, 7 patients were on a Berlin Heart and supported with the EXCOR Active. All patients were initially supported with the IKUS with a median time to transition to the EXCOR Active of 12.0 days (interquartile range [IQR] 9.5, 18.5) and a median time of support with the EXCOR Active of 65.0 days (IQR, 32.0, 81.0). The EXCOR Active posed no significant safety issues, and minimal operating issues were noted. Following the transition from IKUS to the EXCOR Active, there was increased patient and caregiver mobility throughout the hospital. Use of the EXCOR Active has the potential to improve the quality of life in pediatric patients waiting for heart transplantation.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 11","pages":"Pages 1861-1863"},"PeriodicalIF":6.4,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971243","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}
The “International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024” updates and replaces the “Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates—2006” and the “2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update.” The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.
{"title":"International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024","authors":"Yael Peled MD , Anique Ducharme MD, MSc , Michelle Kittleson MD, PhD , Neha Bansal MD , Josef Stehlik MD, MPH , Shahnawaz Amdani MD , Diyar Saeed MD, PhD , Richard Cheng MD, MS , Brian Clarke MD , Fabienne Dobbels PhD , Maryjane Farr MD, MSc , JoAnn Lindenfeld MD , Lazaros Nikolaidis MD , Jignesh Patel MD, PhD , Deepak Acharya MD , Dimpna Albert MD, PhD , Saima Aslam MD , Alejandro Bertolotti MD , Michael Chan MD , Sharon Chih MD , James Walsh BPhty, PhD","doi":"10.1016/j.healun.2024.05.010","DOIUrl":"10.1016/j.healun.2024.05.010","url":null,"abstract":"<div><p>The “International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024” updates and replaces the “Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates—2006” and the “2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update.” The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.</p></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 10","pages":"Pages 1529-1628.e54"},"PeriodicalIF":6.4,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053249824016796/pdfft?md5=04f22b2b4c139931736cd96f456ea388&pid=1-s2.0-S1053249824016796-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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