Pub Date : 2024-10-16DOI: 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.
{"title":"Pathologist Interrater Reliability and Clinical Implications of Elevated Donor-Derived Cell-Free DNA beyond Heart Transplant Rejection.","authors":"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,","doi":"10.1016/j.healun.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.006","url":null,"abstract":"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.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451415","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}
Pub Date : 2024-10-16DOI: 10.1016/j.healun.2024.10.004
Siddhartha G Kapnadak,Tijana Milinic,Kathleen J Ramos
{"title":"Lung re-transplantation for recipients with cystic fibrosis: procedure choice and other considerations.","authors":"Siddhartha G Kapnadak,Tijana Milinic,Kathleen J Ramos","doi":"10.1016/j.healun.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.004","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451417","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}
Pub Date : 2024-10-13DOI: 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.
{"title":"Diagnostic Alignment to Optimize Inter-rater Reliability Among Lung Transplant Pathologists.","authors":"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,","doi":"10.1016/j.healun.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.007","url":null,"abstract":"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.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443665","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}
Pub Date : 2024-10-11DOI: 10.1016/j.healun.2024.10.002
David M Kaye,Christina E Kure,Andreas Wallinder,David C McGiffin
{"title":"Limitations of the Inotrope Score Use as a Measure of Primary Graft Dysfunction.","authors":"David M Kaye,Christina E Kure,Andreas Wallinder,David C McGiffin","doi":"10.1016/j.healun.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.002","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436037","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}
Pub Date : 2024-10-11DOI: 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.
{"title":"Medium to Long-Term Ventricular Assist Device Support in Adults with Congenital Heart Disease.","authors":"Ryan D Byrne,William C Frankel,Ajith Nair,Hari Tunuguntla,Swati Choudhry,Iki Adachi,Edward J Hickey,Andrew B Civitello,Christopher R Broda","doi":"10.1016/j.healun.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.005","url":null,"abstract":"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.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436038","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}
Pub Date : 2024-10-10DOI: 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}
Pub Date : 2024-10-10DOI: 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}
Pub Date : 2024-10-09DOI: 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.
{"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}
Pub Date : 2024-09-18DOI: 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}