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Pathologist Interrater Reliability and Clinical Implications of Elevated Donor-Derived Cell-Free DNA beyond Heart Transplant Rejection. 病理学家的互斥可靠性和供体来源细胞游离 DNA 升高超出心脏移植排斥反应的临床意义。
Pub Date : 2024-10-16 DOI: 10.1016/j.healun.2024.10.006
Aditya Mehta,Jason Goldberg,Pramita Bagchi,Charles Marboe,Keyur B Shah,Samer S Najjar,Steven Hsu,Maria E Rodrigo,Moon Kyoo Jang,Adam Cochrane,Inna F Tchoukina,Hyesik Kong,Brendan J Lohmar,Erick Mcnair,Hannah A Valantine,Sean Agbor-Enoh,Gerald J Berry,Palak Shah,
BACKGROUNDThere is significant variability amongst pathologists in the histopathological interpretation of the endomyocardial biopsy (EMB) for acute cellular rejection (ACR) and assessment of variability in the interpretation of antibody-mediated rejection (AMR) has not been reported. In contemporary practice, the strategy of allograft surveillance with donor-derived cell-free DNA (dd-cfDNA) as compared to EMB has not been compared with a focus on long-term clinical outcomes beyond acute rejection (AR).METHODSThe Genomic Research Alliance for Transplantation (GRAfT) is a multicenter, prospective cohort study that enrolled patients from 2015 to 2020. The center pathologist read was compared to two blinded core cardiac pathologists. ACR and AMR were graded based on the International Society for Heart and Lung Transplantation (ISHLT) criteria. Weighted Cohen's kappa (κ) was used to evaluate interrater reliability between the center and core reads. To assess long-term outcomes, we evaluated a composite of AR, allograft dysfunction, and mortality within 1 year.RESULTSThe study included 94 patients (median age 55 years [IQR 45, 62]), 30% female, 41% Black race) with a total of 429 EMBs and paired dd-cfDNA measures. The concordance rate between center and core pathologists was 77% for ACR (95%CI: 66% - 89%) and 63% for AMR (95%CI: 53% - 74%). 46 patients had an elevation in dd-cfDNA without AR by EMB. The median dd-cfDNA was 0.49% (IQR: 0.35, 1.01) and subsequent AR, allograft dysfunction, or mortality occurred in 59% of these patients at 1 year. In patients with AR by EMB and negative dd-cfDNA (n=5) the composite outcome occurred in 20% of patients at 1 year. At baseline, the positive likelihood ratio (LR+) of dd-cfDNA to detect AR by the center pathologist was 3.74 (95% CI 3.01 - 4.64) and core pathologist was 2.59 (95%CI: 1.95 - 3.45). If the composite outcome was included as a true positive, the LR+ of dd-cfDNA improved to 9.82 (95%CI: 7.04, 13.69) and7.63 (95% CI: 5.61, 10.38) at 1-year, respectively.CONCLUSIONSPathologists interrater reliability is limited in both ACR and AMR. The positive LR of dd-cfDNA when compared to traditional histopathology is limited, but when longitudinal clinical outcomes are included to assess diagnostic performance, the LR+ improves significantly. The value of dd-cfDNA extends beyond the diagnosis of AR to include other clinically meaningful outcomes for patients after heart transplant.
背景病理学家对急性细胞排斥反应(ACR)的心内膜活检(EMB)组织病理学解释存在很大差异,而对抗体介导的排斥反应(AMR)解释的差异评估尚未见报道。方法移植基因组研究联盟(GRAfT)是一项多中心、前瞻性队列研究,从 2015 年到 2020 年招募患者。中心病理学家的读片结果与两位盲法核心心脏病理学家的读片结果进行了比较。根据国际心肺移植学会(ISHLT)标准对 ACR 和 AMR 进行分级。加权科恩卡帕(κ)用于评估中心和核心病理读片之间的相互可靠性。为了评估长期结果,我们对 AR、异体移植功能障碍和 1 年内死亡率进行了综合评估。结果该研究纳入了 94 名患者(中位年龄 55 岁 [IQR:45,62],30% 为女性,41% 为黑人),共有 429 个 EMB 和配对 dd-cfDNA 测量值。中心和核心病理学家之间的 ACR 一致率为 77%(95%CI:66% - 89%),AMR 一致率为 63%(95%CI:53% - 74%)。46 例患者的 dd-cfDNA 升高,但 EMB 无 AR。dd-cfDNA 中位数为 0.49%(IQR:0.35,1.01),这些患者中有 59% 在 1 年后出现 AR、异体移植功能障碍或死亡。在通过 EMB 检测出现 AR 且 dd-cfDNA 阴性的患者中(5 人),20% 的患者在 1 年后出现了综合结果。基线时,中心病理学家检测到 AR 的 dd-cfDNA 阳性似然比 (LR+) 为 3.74 (95%CI 3.01 - 4.64),核心病理学家为 2.59 (95%CI: 1.95 - 3.45)。如果将综合结果列为真阳性,1 年后 dd-cfDNA 的 LR+ 分别提高到 9.82 (95%CI: 7.04, 13.69) 和 7.63 (95%CI: 5.61, 10.38)。与传统的组织病理学相比,dd-cfDNA 的阳性 LR 有限,但如果纳入纵向临床结果来评估诊断性能,LR+ 则会显著提高。dd-cfDNA 的价值不仅限于 AR 的诊断,还包括心脏移植后患者的其他有临床意义的结果。
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引用次数: 0
Lung re-transplantation for recipients with cystic fibrosis: procedure choice and other considerations. 囊性纤维化受者的肺再移植:手术选择和其他考虑因素。
Pub Date : 2024-10-16 DOI: 10.1016/j.healun.2024.10.004
Siddhartha G Kapnadak,Tijana Milinic,Kathleen J Ramos
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引用次数: 0
Diagnostic Alignment to Optimize Inter-rater Reliability Among Lung Transplant Pathologists. 肺移植病理学家之间的诊断调整以优化评分者之间的可靠性。
Pub Date : 2024-10-13 DOI: 10.1016/j.healun.2024.10.007
Elizabeth N Pavlisko,Megan L Neely,Kathryn A Wikenheiser-Brokamp,Gregory A Fishbein,Leslie Litzky,Carol F Farver,Prodipto Pal,Mai He,Peter B Illei,Charuhas Deshpande,Mark A Robien,Jerry Kirchner,Courtney W Frankel,Jason E Lang,John A Belperio,Scott M Palmer,Stuart C Sweet,
BACKGROUNDPoor agreement among lung transplant pathologists has been reported in the assessment of rejection. In addition to acute rejection (AR) and lymphocytic bronchiolitis (LB), acute lung injury (ALI) and organizing pneumonia (OP) were recently identified as histopathologic risk factors for chronic lung allograft dysfunction (CLAD). Therefore, maximizing inter-rater reliability (IRR) for identifying these histopathologic risk factors is important to guide individual patient care and to support incorporating them in inclusion criteria for clinical trials in lung transplantation.METHODSNine pathologists across eight North American lung transplant centers were surveyed for practices in the assessment of lung transplant transbronchial biopsies. We conducted seven diagnostic alignment sessions with pathologists discussing histomorphologic features of CLAD high-risk histopathology. Then, each pathologist blindly scored 75 digitized slides. Fleiss' kappa, accounting for agreement across numerous observers, was used to determine IRR across all raters for presence of any high-risk finding and each individual entity.RESULTSIRR (95% confidence intervals) and % agreement for any high-risk finding (AR, LB, ALI and/or OP) and each individual finding is as follows: Any Finding, k = 0.578 (0.487, 0.668), 78.9%; AR, k = 0.582 (0.481, 0.651), 79.1%; LB, k = 0.683 (0.585, 0.764), 83.5%; ALI, k = 0.418 (0.312, 0.494), 70.9%; OP, k = 0.621 (0.560, 0.714), 81.0%.CONCLUSIONSAfter pre-study diagnostic alignment sessions, a multi-center group of lung transplant pathologists seeking to identify histopathology high-risk for CLAD achieved good IRR.
背景据报道,肺移植病理学家在评估排斥反应时意见不统一。除了急性排斥反应(AR)和淋巴细胞性支气管炎(LB)外,急性肺损伤(ALI)和组织性肺炎(OP)最近也被确定为慢性肺移植功能障碍(CLAD)的组织病理学风险因素。因此,最大限度地提高鉴定这些组织病理学风险因素的评分者间可靠性(IRR)对于指导患者的个体治疗和支持将其纳入肺移植临床试验的纳入标准非常重要。方法我们对北美八个肺移植中心的九位病理学家进行了调查,了解他们在评估肺移植经支气管活检组织病理学方面的做法。我们与病理学家进行了七次诊断对齐会议,讨论 CLAD 高风险组织病理学的组织形态学特征。然后,每位病理学家对 75 张数字化切片进行盲法评分。结果任何高风险发现(AR、LB、ALI和/或OP)和每个单独发现的IRR(95%置信区间)和一致性百分比如下:任何发现,k = 0.578 (0.487, 0.668),78.9%;AR,k = 0.582 (0.481, 0.651),79.1%;LB,k = 0.683 (0.585, 0.764),83.5%;ALI,k = 0.418 (0.312, 0.494),70.9%;OP,k = 0.621 (0.560, 0.714),81.0%。0%.结论经过研究前的诊断对齐会议,一组多中心肺移植病理学家在寻求识别 CLAD 高风险组织病理学时取得了良好的 IRR。
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引用次数: 0
Limitations of the Inotrope Score Use as a Measure of Primary Graft Dysfunction. 用肌注评分衡量原发性移植物功能障碍的局限性。
Pub Date : 2024-10-11 DOI: 10.1016/j.healun.2024.10.002
David M Kaye,Christina E Kure,Andreas Wallinder,David C McGiffin
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引用次数: 0
Medium to Long-Term Ventricular Assist Device Support in Adults with Congenital Heart Disease. 先天性心脏病成人的中长期心室辅助设备支持。
Pub Date : 2024-10-11 DOI: 10.1016/j.healun.2024.10.005
Ryan D Byrne,William C Frankel,Ajith Nair,Hari Tunuguntla,Swati Choudhry,Iki Adachi,Edward J Hickey,Andrew B Civitello,Christopher R Broda
Heart failure is the leading cause of morbidity and mortality in adults with congenital heart disease. Though for many in this population, heart transplantation is not possible or requires longer wait times necessitating prolonged circulatory support. Medium to long-term durable ventricular assist device therapy provides a possible solution. We analyzed outcomes of nine patients with congenital heart disease and at least 3 years of durable mechanical support, all age 18 or older at time of ventricular assist device implantation at our affiliated pediatric and adult hospitals. Palliated congenital anatomies varied and included biventricular physiologies as well as single ventricle with Fontan circulation. Median duration of support was 4.2 years including three patients successfully bridged to transplant averaging 2.1 years on the waitlist. Device-related complications were infrequent with HeartMate 3, a feasible and sustainable option for either bridge to transplant or destination strategies in adults with congenital heart disease.
心力衰竭是先天性心脏病成人患者发病和死亡的主要原因。虽然对这一人群中的许多人来说,心脏移植是不可能的,或者需要较长的等待时间,从而必须长期接受循环支持。中长期持久的心室辅助装置疗法提供了一种可能的解决方案。我们分析了九名先天性心脏病患者的治疗结果,这些患者至少接受了三年的耐久性机械支持,在我们的附属儿科医院和成人医院植入心室辅助装置时年龄都在 18 岁或以上。缓解的先天性解剖结构各不相同,包括双心室生理结构和单心室丰坦循环。中位支持时间为 4.2 年,其中三名患者成功过渡到移植,平均等待时间为 2.1 年。HeartMate 3很少出现设备相关并发症,是成人先天性心脏病患者进行移植桥接或目的地策略的可行且可持续的选择。
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引用次数: 0
Navigating between management of pulmonary arterial hypertension and cardiometabolic and pulmonary comorbidities. 在肺动脉高压与心脏代谢和肺部合并症的管理之间游刃有余。
Pub Date : 2024-10-10 DOI: 10.1016/j.healun.2024.09.016
Hakim Ghani,Joanna Pepke-Zaba
{"title":"Navigating between management of pulmonary arterial hypertension and cardiometabolic and pulmonary comorbidities.","authors":"Hakim Ghani,Joanna Pepke-Zaba","doi":"10.1016/j.healun.2024.09.016","DOIUrl":"https://doi.org/10.1016/j.healun.2024.09.016","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142431122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A supply-based scoring approach to account for biological disadvantages in accessing lung transplant. 以供应为基础的评分方法,考虑到肺移植手术中的生理劣势。
Pub Date : 2024-10-10 DOI: 10.1016/j.healun.2024.09.022
Johnie Rose,Paul R Gunsalus,Carli J Lehr,Mark F Swiler,Jarrod E Dalton,Maryam Valapour
BACKGROUNDThe lung Composite Allocation Score (CAS) accounts separately for biological disadvantages stemming from candidate blood type and height using consensus-derived heuristics, which do not reflect the true supply of compatible organs available to candidates with specific combinations of blood type and height. Here, we develop an alternative CAS biological disadvantages subscore using a novel measure of donor supply.METHODSUsing Scientific Registry of Transplant Recipients data from February 19, 2015 to September 1, 2021, we modeled daily distance-adjusted supply of compatible donors, as a function of candidate blood type, height, and diagnosis group, using Poisson rate regression and applied the model to create a 10-point supply-based subscore. Substituting this subscore in place of the 10 total points allocated to blood type and height in CAS created a "Supply-Adjusted CAS". We simulated population outcomes under Supply-Adjusted CAS, original CAS (March 2023) and "ABO Modified" CAS (September 2023).RESULTSThe supply-based subscore was more responsive to variations in candidate blood type, height, and diagnosis group than corresponding CAS or ABO-Modified CAS subscores. In simulation, waitlist mortality improved from 13.95 per 100 waitlist years under CAS and 14.12 under ABO-Modified CAS to 13.09 under Supply-Adjusted CAS. Transplant rates improved from 121.6 and 126.2 under CAS and ABO-Modified CAS, respectively, to 128.8 under Supply-Adjusted CAS. Height disparities improved substantially, while blood type disparities grew slightly relative to ABO-Modified CAS.CONCLUSIONSSupply-Adjusted CAS may improve lung transplant population outcomes overall while providing a more empirically based method to address equity.
背景肺部综合分配评分(CAS)使用共识启发式方法分别考虑了候选者血型和身高造成的生物学劣势,但这并不能反映具有特定血型和身高组合的候选者可获得的相容器官的真实供应情况。方法利用移植受者科学登记处从 2015 年 2 月 19 日到 2021 年 9 月 1 日的数据,我们使用泊松率回归法建立了相容供体的每日距离调整供应模型,作为候选者血型、身高和诊断组的函数,并应用该模型创建了一个基于供应的 10 分子分数。在 CAS 中,血型和身高的总分为 10 分,用这一子分数代替血型和身高的总分,就得到了 "供应调整 CAS"。我们模拟了 "供应调整 CAS"、原始 CAS(2023 年 3 月)和 "ABO 修正 CAS"(2023 年 9 月)下的人群结果。结果与相应的 CAS 或 ABO 修正 CAS 子分数相比,基于供应的子分数对候选血型、身高和诊断组的变化反应更灵敏。在模拟中,候选者死亡率从 CAS 的每 100 个候选年 13.95 例和 ABO 改良 CAS 的每 100 个候选年 14.12 例提高到供应调整 CAS 的每 100 个候选年 13.09 例。移植率分别从 CAS 和 ABO 改良 CAS 的 121.6 和 126.2 提高到供应调整 CAS 的 128.8。结论供应调整 CAS 可以改善肺移植人群的整体结果,同时提供一种更基于经验的方法来解决公平问题。
{"title":"A supply-based scoring approach to account for biological disadvantages in accessing lung transplant.","authors":"Johnie Rose,Paul R Gunsalus,Carli J Lehr,Mark F Swiler,Jarrod E Dalton,Maryam Valapour","doi":"10.1016/j.healun.2024.09.022","DOIUrl":"https://doi.org/10.1016/j.healun.2024.09.022","url":null,"abstract":"BACKGROUNDThe lung Composite Allocation Score (CAS) accounts separately for biological disadvantages stemming from candidate blood type and height using consensus-derived heuristics, which do not reflect the true supply of compatible organs available to candidates with specific combinations of blood type and height. Here, we develop an alternative CAS biological disadvantages subscore using a novel measure of donor supply.METHODSUsing Scientific Registry of Transplant Recipients data from February 19, 2015 to September 1, 2021, we modeled daily distance-adjusted supply of compatible donors, as a function of candidate blood type, height, and diagnosis group, using Poisson rate regression and applied the model to create a 10-point supply-based subscore. Substituting this subscore in place of the 10 total points allocated to blood type and height in CAS created a \"Supply-Adjusted CAS\". We simulated population outcomes under Supply-Adjusted CAS, original CAS (March 2023) and \"ABO Modified\" CAS (September 2023).RESULTSThe supply-based subscore was more responsive to variations in candidate blood type, height, and diagnosis group than corresponding CAS or ABO-Modified CAS subscores. In simulation, waitlist mortality improved from 13.95 per 100 waitlist years under CAS and 14.12 under ABO-Modified CAS to 13.09 under Supply-Adjusted CAS. Transplant rates improved from 121.6 and 126.2 under CAS and ABO-Modified CAS, respectively, to 128.8 under Supply-Adjusted CAS. Height disparities improved substantially, while blood type disparities grew slightly relative to ABO-Modified CAS.CONCLUSIONSSupply-Adjusted CAS may improve lung transplant population outcomes overall while providing a more empirically based method to address equity.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ISHLT consensus statement on the perioperative use of ECLS in lung transplantation: Part II: Intraoperative considerations. ISHLT 关于肺移植围手术期使用 ECLS 的共识声明:第二部分:术中注意事项。
Pub Date : 2024-10-09 DOI: 10.1016/j.healun.2024.08.027
Archer Kilbourne Martin,Olaf Mercier,Ashley Virginia Fritz,Theresa A Gelzinis,Konrad Hoetzenecker,Sandra Lindstedt,Nandor Marczin,Barbara J Wilkey,Marc Schecter,Haifa Lyster,Melissa Sanchez,James Walsh,Orla Morrissey,Bronwyn Levvey,Caroline Landry,Siavosh Saatee,Sakhee Kotecha,Juergen Behr,Jasleen Kukreja,Göran Dellgren,Julien Fessler,Brandi Bottiger,Keith Wille,Kavita Dave,Basil S Nasir,David Gomez-De-Antonio,Marcelo Cypel,Anna K Reed
The use of extracorporeal life support (ECLS) throughout the perioperative phase of lung transplantation requires nuanced planning and execution by an integrated team of multidisciplinary experts. To date, no multidisciplinary consensus document has examined the perioperative considerations of how to best manage these patients. To address this challenge, this perioperative utilization of ECLS in lung transplantation consensus statement was approved for development by the International Society for Heart and Lung Transplantation Standards and Guidelines Committee. International experts across multiple disciplines, including cardiothoracic surgery, anesthesiology, critical care, pediatric pulmonology, adult pulmonology, pharmacy, psychology, physical therapy, nursing, and perfusion, were selected based on expertise and divided into subgroups examining the preoperative, intraoperative, and postoperative periods. Following a comprehensive literature review, each subgroup developed recommendations to examine via a structured Delphi methodology. Following 2 rounds of Delphi consensus, a total of 39 recommendations regarding intraoperative considerations for ECLS in lung transplantation met consensus criteria. These recommendations focus on the planning, implementation, management, and monitoring of ECLS throughout the entire intraoperative period.
在肺移植围手术期使用体外生命支持(ECLS)需要多学科专家组成的综合团队进行细致的规划和执行。迄今为止,还没有一份多学科共识文件对如何最佳管理这些患者的围手术期注意事项进行过研究。为了应对这一挑战,国际心肺移植学会标准和指南委员会批准制定了这份肺移植围手术期使用 ECLS 的共识声明。国际专家来自多个学科,包括心胸外科、麻醉学、重症监护、儿科肺病学、成人肺病学、药学、心理学、理疗学、护理学和灌注学,他们根据专业知识进行筛选,并分成若干个小组,分别对术前、术中和术后进行检查。在进行了全面的文献综述后,各分组通过结构化德尔菲法提出了研究建议。经过两轮德尔菲共识,共有 39 项关于肺移植术中 ECLS 术中注意事项的建议符合共识标准。这些建议重点关注整个术中期间 ECLS 的计划、实施、管理和监控。
{"title":"ISHLT consensus statement on the perioperative use of ECLS in lung transplantation: Part II: Intraoperative considerations.","authors":"Archer Kilbourne Martin,Olaf Mercier,Ashley Virginia Fritz,Theresa A Gelzinis,Konrad Hoetzenecker,Sandra Lindstedt,Nandor Marczin,Barbara J Wilkey,Marc Schecter,Haifa Lyster,Melissa Sanchez,James Walsh,Orla Morrissey,Bronwyn Levvey,Caroline Landry,Siavosh Saatee,Sakhee Kotecha,Juergen Behr,Jasleen Kukreja,Göran Dellgren,Julien Fessler,Brandi Bottiger,Keith Wille,Kavita Dave,Basil S Nasir,David Gomez-De-Antonio,Marcelo Cypel,Anna K Reed","doi":"10.1016/j.healun.2024.08.027","DOIUrl":"https://doi.org/10.1016/j.healun.2024.08.027","url":null,"abstract":"The use of extracorporeal life support (ECLS) throughout the perioperative phase of lung transplantation requires nuanced planning and execution by an integrated team of multidisciplinary experts. To date, no multidisciplinary consensus document has examined the perioperative considerations of how to best manage these patients. To address this challenge, this perioperative utilization of ECLS in lung transplantation consensus statement was approved for development by the International Society for Heart and Lung Transplantation Standards and Guidelines Committee. International experts across multiple disciplines, including cardiothoracic surgery, anesthesiology, critical care, pediatric pulmonology, adult pulmonology, pharmacy, psychology, physical therapy, nursing, and perfusion, were selected based on expertise and divided into subgroups examining the preoperative, intraoperative, and postoperative periods. Following a comprehensive literature review, each subgroup developed recommendations to examine via a structured Delphi methodology. Following 2 rounds of Delphi consensus, a total of 39 recommendations regarding intraoperative considerations for ECLS in lung transplantation met consensus criteria. These recommendations focus on the planning, implementation, management, and monitoring of ECLS throughout the entire intraoperative period.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Recurrence of Pulmonary Arterial Hypertension 32 months after bilateral lung transplant. 双肺移植 32 个月后肺动脉高压复发。
Pub Date : 2024-10-05 DOI: 10.1016/j.healun.2024.09.030
O Kurn,C Patterson,J Cannon,K Sheares,D Taboada,A Yousuf,K Bunclark
{"title":"Recurrence of Pulmonary Arterial Hypertension 32 months after bilateral lung transplant.","authors":"O Kurn,C Patterson,J Cannon,K Sheares,D Taboada,A Yousuf,K Bunclark","doi":"10.1016/j.healun.2024.09.030","DOIUrl":"https://doi.org/10.1016/j.healun.2024.09.030","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"226 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142385288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes of Single vs. Double Lung Retransplantation in Patients with Cystic Fibrosis. 囊性纤维化患者单肺再移植与双肺再移植的疗效。
Pub Date : 2024-09-18 DOI: 10.1016/j.healun.2024.09.010
Emily L Larson,Albert Leng,Jessica M Ruck,Alfred J Casillan,Alice L Zhou,Jinny S Ha,Pali D Shah,Natalie E West,Christian A Merlo,Errol L Bush
OBJECTIVEPatients requiring lung transplant for cystic fibrosis (CF) may require retransplant due to limited graft survival and otherwise excellent life expectancy. Optimal transplant strategy for this population, including single vs. double lung retransplant, has not been established.METHODSWe performed a retrospective analysis of the UNOS/OPTN database to identify adult lung retransplant recipients from 2005-2021 with a primary diagnosis of CF. Patients were stratified by retransplant type (single lung [re-SLTx] vs. double lung [re-DLTx] retransplant). Descriptive statistics, Kaplan-Meier survival analysis, and multivariable Cox regression were performed.RESULTSFrom 2005-2021, 384 recipients underwent retransplant after an initial transplant for an indication of CF; more recipients underwent re-DLTx (N=337 [87.8%]) than re-SLTx (N=47 [12.2%]). The median (IQR) time from initial transplant to retransplant was similar between re-SLTx and re-DLTx recipients (4.4 [2.9-8.6] vs. 4.6 [2.6-7.4] years, p=0.73). Ischemic time was shorter and lung allocation score was lower for re-SLTx than re-DLTx recipients. Median survival after retransplant was significantly shorter for re-SLTx vs. re-DLTx recipients (2.0 [95% CI 1.2-3.5] vs. 4.3 [95% CI 3.5-6.1] years post-retransplant, p=0.008). Median survival for adults with CF undergoing primary transplant for CF in the same period was 9.1 (8.5-9.9) years. After adjusting for donor and recipient characteristics, re-SLTx in patients with CF was associated with 88% higher hazard of mortality than re-DLTx (aHR=1.88 [95% CI 1.28-2.78], p=0.001).CONCLUSIONSIn this analysis of lung retransplant in recipients with CF, re-SLTx was associated with a higher hazard of mortality compared to re-DLTx, supporting re-DLTx as treatment for this population.
目的:因囊性纤维化(CF)而需要进行肺移植的患者可能会因移植存活率有限而需要再次移植,否则他们的预期寿命会非常长。我们对 UNOS/OPTN 数据库进行了一项回顾性分析,以确定 2005-2021 年期间主要诊断为 CF 的成人肺再移植受者。根据再移植类型(单肺 [re-SLTx] 与双肺 [re-DLTx] 再移植)对患者进行分层。结果2005-2021年间,384名受者因CF指征在初次移植后接受了再移植;接受再DLTx(337人[87.8%])的受者多于接受再SLTx(47人[12.2%])的受者。再SLTx和再DLTx受者从初次移植到再次移植的中位(IQR)时间相似(4.4 [2.9-8.6] 年 vs. 4.6 [2.6-7.4] 年,P=0.73)。与再DLTx受者相比,再SLTx受者缺血时间更短,肺分配评分更低。与再DLTx受者相比,再SLTx受者再移植后的中位生存期明显缩短(再移植后2.0 [95% CI 1.2-3.5] 年 vs. 4.3 [95% CI 3.5-6.1] 年,P=0.008)。同期因CF而接受初次移植的成人CF患者的中位生存期为9.1 (8.5-9.9)年。在对供体和受体特征进行调整后,CF 患者的再 SLTx 死亡率比再 DLTx 高 88%(aHR=1.88 [95% CI 1.28-2.78],p=0.001)。
{"title":"Outcomes of Single vs. Double Lung Retransplantation in Patients with Cystic Fibrosis.","authors":"Emily L Larson,Albert Leng,Jessica M Ruck,Alfred J Casillan,Alice L Zhou,Jinny S Ha,Pali D Shah,Natalie E West,Christian A Merlo,Errol L Bush","doi":"10.1016/j.healun.2024.09.010","DOIUrl":"https://doi.org/10.1016/j.healun.2024.09.010","url":null,"abstract":"OBJECTIVEPatients requiring lung transplant for cystic fibrosis (CF) may require retransplant due to limited graft survival and otherwise excellent life expectancy. Optimal transplant strategy for this population, including single vs. double lung retransplant, has not been established.METHODSWe performed a retrospective analysis of the UNOS/OPTN database to identify adult lung retransplant recipients from 2005-2021 with a primary diagnosis of CF. Patients were stratified by retransplant type (single lung [re-SLTx] vs. double lung [re-DLTx] retransplant). Descriptive statistics, Kaplan-Meier survival analysis, and multivariable Cox regression were performed.RESULTSFrom 2005-2021, 384 recipients underwent retransplant after an initial transplant for an indication of CF; more recipients underwent re-DLTx (N=337 [87.8%]) than re-SLTx (N=47 [12.2%]). The median (IQR) time from initial transplant to retransplant was similar between re-SLTx and re-DLTx recipients (4.4 [2.9-8.6] vs. 4.6 [2.6-7.4] years, p=0.73). Ischemic time was shorter and lung allocation score was lower for re-SLTx than re-DLTx recipients. Median survival after retransplant was significantly shorter for re-SLTx vs. re-DLTx recipients (2.0 [95% CI 1.2-3.5] vs. 4.3 [95% CI 3.5-6.1] years post-retransplant, p=0.008). Median survival for adults with CF undergoing primary transplant for CF in the same period was 9.1 (8.5-9.9) years. After adjusting for donor and recipient characteristics, re-SLTx in patients with CF was associated with 88% higher hazard of mortality than re-DLTx (aHR=1.88 [95% CI 1.28-2.78], p=0.001).CONCLUSIONSIn this analysis of lung retransplant in recipients with CF, re-SLTx was associated with a higher hazard of mortality compared to re-DLTx, supporting re-DLTx as treatment for this population.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
The Journal of Heart and Lung Transplantation
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