Journal: J Heart Lung Transplant

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<div><h4>Lung Transplantation for Lung Cancer: a Systematic Review of the Literature.</h4><i>Elsolh B, Bayat Z, Lyu D, Lin J, Wakeam E</i><br /><b>Objective</b><br />Lung transplant (LTx) is an accepted treatment for end-stage pulmonary failure. A small proportion of explanted lungs harbor incidentally identified non-small cell lung cancers (NSCLC). We review the literature on studies assessing LTx patients found to have NSCLC lung cancer in their explanted lungs, and perform a pooled analysis of outcomes.<br /><b>Methods</b><br />MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. We included studies assessing outcomes of patients with incidentally identified NSCLC following LTx, or following LTx for diffuse lepidic adenocarcinoma as a primary indication.<br /><b>Results</b><br />A total of 1,404 articles were reviewed. 17 eligible studies were identified: 14 studies on incidental NSCLC (N=169), 4 on diffuse lepidic adenocarcinoma (N=70). Overall survival for patients with incidentally identified lung cancer at 1-year, 3-years, and 5-years was 60.8% (95%CI 43.7 - 77.9%, I<sup>2</sup> = 81.8%), 25.5% (95%CI 1.6 - 49.5%, I<sup>2</sup> = 93.6%), and 23.0% (95%CI 2.0 - 44.0%, I<sup>2</sup> = 92.0%) respectively. When restricted to those with earlier stage disease, those with stage I or II NSCLC had better 1-year, 3-year, and 5-year OS at 72.7% (95%CI 57.2 - 88.2%, I<sup>2</sup> = 67.3%), 41.6% (95%CI 14.0 - 69.1%, I<sup>2</sup> = 89.1%), and 34.5% (95%CI 8.1 - 61.0%, I<sup>2</sup> = 89.8%) respectively. A sensitivity analysis limited to stage I showed 1-year, 3-year, and 5-year survival of 73.0% (95%CI 56.3 - 89.7%), 40.4% (95%CI 110.3 - 70.6%), and 35.4% (95%CI 6.2 - 64.5%) respectively. The 4 studies on diffuse lepidic adenocarcinoma were too heterogeneous for pooled analysis.<br /><b>Conclusions</b><br />We present a review and pooled analysis examining survival following LTx with incidentally identified NSCLC. Patients with earlier stage incidentally explanted NSCLC had better survival outcomes. Overall survival in the Stage I population approximates that of LTx without incidental NSCLC.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 28 May 2023; epub ahead of print</small></div>
Elsolh B, Bayat Z, Lyu D, Lin J, Wakeam E
J Heart Lung Transplant: 28 May 2023; epub ahead of print | PMID: 37253398
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<div><h4>Dynamics of bacterial pathogens at the driveline exit site in patients with ventricular assist devices: a prospective, observational, single-centre cohort study.</h4><i>Pitton M, Valente LG, Oberhaensli S, Casanova C, ... Que YA, Fürholz M</i><br /><b>Background</b><br />Driveline infections (DLIs) at the exit site are frequent in patients with left ventricular assist devices (LVADs). The dynamics from colonization to infection are yet to be investigated. We combined systematic swabbing at the driveline exit site and genomic analyses to study the dynamics of bacterial pathogens and get insights into DLIs pathogenesis.<br /><b>Methods</b><br />A prospective, observational, single-centre cohort study at the University Hospital of Bern, Switzerland was performed. Patients with LVAD were systematically swabbed at the driveline exit site between June 2019 and December 2021, irrespective of signs and symptoms of DLI. Bacterial isolates were identified and a subset was whole-genome sequenced.<br /><b>Results</b><br />Fifty-three patients were screened, of which 45 (84.9%) were included in the final population. Bacterial colonization at the driveline exit site without manifestation of DLI was frequent and observed in 17 patients (37.8%). Twenty-two patients (48.9%) developed at least one DLI episode over the study period. Incidence of DLIs reached 2.3 cases per 1,000 LVAD days. The majority of the organisms cultivated from exit sites were Staphylococcus species. Genome analysis revealed that bacteria persisted at the driveline exit site over time. In four patients, transition from colonization to clinical DLI was observed.<br /><b>Conclusion</b><br />Our study is the first to address bacterial colonization in the LVAD-DLI setting. We observed that bacterial colonization at the driveline exit site was a frequent phenomenon, and in a few cases it preceded clinically relevant infections. We also provided acquisition of hospital-acquired multidrug-resistant bacteria and the transmission of pathogens between patients.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 26 May 2023; epub ahead of print</small></div>
Pitton M, Valente LG, Oberhaensli S, Casanova C, ... Que YA, Fürholz M
J Heart Lung Transplant: 26 May 2023; epub ahead of print | PMID: 37245557
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<div><h4>Contribution of skin cancer to overall healthcare costs of lung transplantation in Queensland, Australia.</h4><i>Gordon LG, Hopkins P, Chambers D, Green AC</i><br /><b>Background</b><br />Skin cancers are a major source of morbidity in lung transplant recipients but relative costs associated with their treatment are unknown.<br /><b>Methods</b><br />We prospectively followed 90 lung transplant recipients from enrolment in the Skin Tumours in Allograft Recipients study in 2013 to 2015, until mid-2016. We undertook a cost-analysis to quantify the health system costs relating to the index transplant episode, and ongoing costs for four years. Linked data from surveys, Australian Medicare claims and hospital accounting systems were used and generalized linear models were employed.<br /><b>Results</b><br />Median initial hospitalisation costs of lung transplantation were AU$115,831 (interquartile range (IQR) $87,428 - $177,395). In total, 57/90 (63%) participants were treated for skin cancers during follow-up at a total cost of AU$44,038. Among these 57, total government costs per person (mostly of pharmaceuticals) over four years, were median AU$68,489 (IQR $44,682 - $113,055) vs AU$59,088 (IQR $38,190 - $94,906) among those without skin cancer, with the difference predominantly driven by more doctors\' visits, and higher pathology and procedural costs. Healthcare costs overall were also significantly higher in those treated for skin cancers (cost ratio 1.50, 95%CI: 1.09, 2.06) after adjusting for underlying lung disease, age on enrolment, years of immunosuppression and number of treated comorbidities.<br /><b>Conclusion</b><br />Skin cancer care is a small component of overall costs. While all lung transplant recipients with comorbidities have substantial healthcare costs, those affected by skin cancer incur even greater healthcare costs than those without, highlighting the importance of skin cancer control.<br /><br />Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 25 May 2023; epub ahead of print</small></div>
Gordon LG, Hopkins P, Chambers D, Green AC
J Heart Lung Transplant: 25 May 2023; epub ahead of print | PMID: 37244434
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<div><h4>Association of High-Priority Exceptions with Waitlist Mortality Among Heart Transplant Candidates.</h4><i>Johnson DY, Ahn D, Lazenby K, Zeng S, ... Khush K, Parker WF</i><br /><b>Background</b><br />The US heart allocation system ranks candidates using six categorical status levels. Transplant programs can request exceptions to increase a candidate\'s status level if they believe their candidate has the same medical urgency as candidates who meet the standard criteria for that level. We aimed to determine if exception candidates have the same medical urgency as standard candidates.<br /><b>Methods</b><br />Using the Scientific Registry of Transplant Recipients, we constructed a longitudinal waitlist history dataset of adult heart-only transplant candidates listed between October 18, 2018 and December 1, 2021. We estimated the association between exceptions and waitlist mortality with a mixed-effects Cox proportional hazards model that treated status and exceptions as time-dependent covariates.<br /><b>Results</b><br />Out of 12,458 candidates listed during the study period, 2,273 (18.2%) received an exception at listing and 1,957 (15.7%) received an exception after listing. After controlling for status, exception candidates had approximately half the risk of waitlist mortality as standard candidates (HR 0.55, 95% CI [0.41, 0.73], p < 0.001). Exceptions were associated with a 51% lower risk of waitlist mortality among Status 1 candidates (HR 0.49, 95% CI [0.27, 0.91], p = 0.023) and a 61% lower risk among Status 2 candidates (HR 0.39, 95% CI [0.24, 0.62], p < 0.001).<br /><b>Conclusions</b><br />Under the new heart allocation policy, exception candidates had significantly lower waitlist mortality than standard candidates, including exceptions for the highest priority statuses. These results suggest that candidates with exceptions, on average, have a lower level of medical urgency than candidates who meet standard criteria.<br /><br />Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 22 May 2023; epub ahead of print</small></div>
Johnson DY, Ahn D, Lazenby K, Zeng S, ... Khush K, Parker WF
J Heart Lung Transplant: 22 May 2023; epub ahead of print | PMID: 37225029
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<div><h4>Effect of the UNOS policy change on rates of rejection, infection and hospital readmission following heart transplantation.</h4><i>Vaidya AS, Lee ES, Kawaguchi ES, DePasquale EC, ... Lee R, Wolfson AM</i><br /><b>Background</b><br />The 2018 adult heart allocation policy sought to improve waitlist risk stratification, reduce waitlist mortality and increase organ access. This system prioritized patients at greatest risk for waitlist mortality, especially individuals requiring temporary mechanical circulatory support (tMCS). Post-transplant complications are significantly higher in patients on tMCS before transplantation, and early post-transplant complications impact long-term mortality. We sought to determine if policy change affected early post-transplant complication rates of rejection, infection and hospitalization.<br /><b>Methods</b><br />We included all adult, heart-only, single-organ heart transplant recipients from the UNOS registry with pre-policy (PRE) individuals transplanted between 11/1/2016 to 10/31/2017 and post-policy (POST) between 11/1/2018 to 10/31/2019. We used a multivariable logistic regression analysis to assess the effect of policy change on post-transplant rejection, infection, and hospitalization. Two COVID-19 eras (2019-2020, 2020-2021) were included in our analysis.<br /><b>Results</b><br />The majority of baseline characteristics were comparable between PRE and POST era recipients. The odds of treated rejection (p=0.8), hospitalization (p=0.69), and hospitalization due to rejection (p=0.76) and infection (p=0.66) were similar between PRE and POST eras; there was a trend towards reduced odds of rejection (p=0.08). In both COVID eras, there was a clear reduction in rejection and treated rejection with no effect on hospitalization for rejection or infection. Odds of all-cause hospitalization was increased in both COVID eras.<br /><b>Conclusion</b><br />The UNOS policy change improves access to heart transplantation for higher acuity patients without increasing early post-transplant rates of treated rejection or hospitalization for rejection or infection, factors which portend risk for long-term post-transplant mortality.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 19 May 2023; epub ahead of print</small></div>
Vaidya AS, Lee ES, Kawaguchi ES, DePasquale EC, ... Lee R, Wolfson AM
J Heart Lung Transplant: 19 May 2023; epub ahead of print | PMID: 37211332
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<div><h4>Machine Learning for Clustering and Post-closure Outcome of Adult CHD-PAH Patients with Borderline Hemodynamics.</h4><i>Luo D, Zheng X, Yang Z, Li H, Fei H, Zhang C</i><br /><b>Background</b><br />Patients with uncorrected isolated simple shunts associated pulmonary arterial hypertension (PAH) had increased mortality. Treatment strategies for borderline hemodynamics remain controversial. This study aims to investigate pre-closure characteristics and its association with post-closure outcome in this group of patients.<br /><b>Methods</b><br />Adults with uncorrected isolated simple shunts associated PAH were included. Peak tricuspid regurgitation velocity <2.8m/s with normalized cardiac structures was defined as the favorable study outcome. We applied unsupervised and supervised machine learning for clustering analysis and model constructions.<br /><b>Results</b><br />Finally, 246 patients were included. During a median follow-up of 414 days, 58.49% (62/106) of patients with pre-tricuspid shunts achieved favorable outcome while 32.22% (46/127) of patients with post-tricuspid shunts. In unsupervised learning, two clusters were identified in both types of shunts. Generally, the oxygen saturation, pulmonary blood flow, cardiac index, dimensions of the right and left atrium, were the major features that characterized the identified clusters. Specifically, mean right atrial pressure, right ventricular dimension and right ventricular outflow tract helped differentiate clusters in pre-tricuspid shunts while age, aorta dimension and systemic vascular resistance helped differentiate clusters for post-tricuspid shunts. Notably, cluster 1 had better post-closure outcome than cluster 2 (70.83% vs. 32.55%, P<0.001 for pre-tricuspid and 48.10% vs. 16.67%, P<0.001 for post-tricuspid). However, models constructed from supervised learning methods did not achieve good accuracy for predicting the post-closure outcome.<br /><b>Conclusions</b><br />There were two main clusters in patients with borderline hemodynamics, in which one cluster had better post-closure outcome than the other.<br /><b>Data availability statement</b><br />The datasets and analyzed codes are available upon reasonable request from the corresponding author.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 19 May 2023; epub ahead of print</small></div>
Luo D, Zheng X, Yang Z, Li H, Fei H, Zhang C
J Heart Lung Transplant: 19 May 2023; epub ahead of print | PMID: 37211333
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<div><h4>Thoracoabdominal Normothermic Regional Perfusion in Donation after Circulatory Death Does Not Restore Brain Blood Flow.</h4><i>Frontera JA, Lewis A, James L, Melmed K, ... Smith DE, Moazami N</i><br /><AbstractText>Use of thoraco-abdominal normothermic regional perfusion (TA-NRP) during donation after circulatory death (DCD) is an important advance in organ donation. Prior to establishing TA-NRP, the brachiocephalic, left carotid, and left subclavian arteries are ligated, thereby eliminating anterograde brain blood flow via the carotid and vertebral arteries. While theoretical concerns have been voiced that TA-NRP after DCD may restore brain blood flow via collaterals, there have been no studies to confirm or refute this possibility. We evaluated brain blood flow using intraoperative transcranial Doppler (TCD) in two DCD TA-NRP cases. Pre-extubation, anterior and posterior circulation brain blood flow waveforms were present in both cases, similar to the waveforms detected in a control patient on mechanical circulatory support undergoing cardiothoracic surgery. Following declaration of death and initiation of TA-NRP, no brain blood flow was detected in either case. Additionally, there was absence of brainstem reflexes, no response to noxious stimuli and no respiratory effort. These TCD results demonstrate that DCD with TA-NRP did not restore brain blood flow.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 19 May 2023; epub ahead of print</small></div>
Frontera JA, Lewis A, James L, Melmed K, ... Smith DE, Moazami N
J Heart Lung Transplant: 19 May 2023; epub ahead of print | PMID: 37211334
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<div><h4>Natural History of Chronic Thromboembolic Pulmonary Disease with no or mild Pulmonary Hypertension.</h4><i>Ashwin Reddy S, Swietlik EM, Robertson L, Michael A, ... Toshner MR, Pepke-Zaba J</i><br /><b>Introduction</b><br />We describe baseline characteristics, disease progression and mortality in chronic thromboembolic pulmonary disease (CTEPD) patients as a function of mean pulmonary artery pressure (mPAP) according to new and previous definitions of pulmonary hypertension (PH).<br /><b>Method</b><br />All patients diagnosed with CTEPD between January 2015 and December 2019 were dichotomised according to initial mPAP: ≤20mmHg (\'normal\') vs. 21-24mmHg (\'mildly-elevated\'). Baseline features were compared between the groups, and pairwise analysis performed to determine changes in clinical endpoints at 1-year, excluding those who underwent pulmonary endarterectomy (PEA) or did not attend follow-up. Mortality was assessed for the whole cohort over the entire study period.<br /><b>Results</b><br />113 patients were included; 57 had mPAP ≤20mmHg and 56 had mPAP 21-24mmHg. Normal mPAP patients had lower pulmonary vascular resistance (PVR) (1.6 vs 2.5WU, p < 0.01) and right ventricular end-diastolic pressure (RVEDP) (5.9 vs 7.8mmHg, p<0.01) at presentation. At 3 years no major deterioration was seen in either group. No patients were treated with pulmonary artery vasodilators. 8 had undergone PEA. Over 37 months median follow-up, mortality was 7.0% in the normal mPAP group and 8.9% in the mildly-elevated mPAP group. Cause of death was malignancy in 62.5% of cases.<br /><b>Conclusion</b><br />CTEPD patients with mild PH have statistically higher RVEDP and PVR than those with mPAP ≤20mmHg. Baseline characteristics were otherwise similar. Neither group displayed disease progression on non-invasive tests up to 3 years. Mortality over 37 months follow-up is 8%, and mainly attributable to malignancy. Further prospective study is required to validate these findings.<br /><br />Copyright © 2023 International Society for the Heart and Lung Transplantation. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 16 May 2023; epub ahead of print</small></div>
Ashwin Reddy S, Swietlik EM, Robertson L, Michael A, ... Toshner MR, Pepke-Zaba J
J Heart Lung Transplant: 16 May 2023; epub ahead of print | PMID: 37201688
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<div><h4>Infections following Left Ventricular Assist Device Implantation and 1-Year Health-related Quality of Life.</h4><i>Zhou S, Yang G, Hou H, Zhang M, ... Likosky DS, Michigan Congestive Heart Failure Investigators</i><br /><b>Background</b><br />Left ventricular assist device (LVAD) implantation leads to substantial and sustained improvement in health-related quality of life (HRQOL) among patients. Infection following device implantation remains an important and frequent complication and adversely affects patient-reported HRQOL.<br /><b>Methods</b><br />Patients in The Society of Thoracic Surgeons\' Interagency Registry for Mechanically Assisted Circulatory Support receiving a primary LVAD between April 2012 to October 2016 were included. The primary exposure was one-year post-implant infection, characterized by: (1) any infection; (2) total number of infections and (3) type (LVAD-specific, LVAD-related, non-LVAD). The association between infection and the primary composite adverse outcome (defined as EuroQoL Visual Analog Scale <65, too sick to complete the survey, or death at 1-year) was estimated using inverse probability weighting and Cox regression.<br /><b>Results</b><br />The study cohort included 11,618 patients from 161 medical centers with 4,768 (41.0%) patients developing an infection, and 2,282 (19.6%) patients having >1 infection during the follow up period. The adjusted odds ratio (OR<sub>adj</sub>) for the primary composite adverse outcome was 1.22 (95%CI 1.19-1.24, p<0.001) for each additional infection. Each additional infection was associated with a 3.49% greater probability of the primary composite outcome and was associated with worse performance across multiple dimensions of HRQOL as assessed by the EQ-5D for patients who survived to 1 year.<br /><b>Conclusions</b><br />For patients undergoing LVAD implantation, each additional infection within the first post-implantation year was associated with an incremental negative effect on survival free of impaired HRQOL.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 13 May 2023; epub ahead of print</small></div>
Zhou S, Yang G, Hou H, Zhang M, ... Likosky DS, Michigan Congestive Heart Failure Investigators
J Heart Lung Transplant: 13 May 2023; epub ahead of print | PMID: 37187319
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<div><h4>Lung Transplant Survival with Past and Concomitant Cardiac Revascularization.</h4><i>Tran T, Kashem MA, Firoz A, Yanagida R, Shigemura N, Toyoda Y</i><br /><b>Background</b><br />Coronary artery disease (CAD) is common among lung transplant (LTx) candidates and has historically been viewed as a contraindication to the procedure. Survival outcomes of lung transplant recipients with concomitant coronary artery disease who had prior or perioperative revascularization remain a topic of conversation.<br /><b>Methods</b><br />A retrospective analysis of all single and double lung transplant patients from Feb-2012 to Aug-2021 at a single center was performed (n = 880). Patients were split into 4 groups: (1) those who received a preoperative percutaneous coronary intervention, (2) those who received pre-operative coronary artery bypass grafting (CABG), (3) those who received CABG during transplantation, and (4) those who had lung transplantation without revascularization. Groups were compared for demographics, surgical procedure, and survival outcomes using STATA Inc. P-value <0.05 was considered significant.<br /><b>Results</b><br />Most patients receiving LTx were males = and white. Pump type (p 0.810), total ischemic time (p 0.994), warm ischemic time (p 0.479), length of stay (p 0.751), and lung allocation score (p 0.332) were not significantly different between the four groups. The no revascularization group was younger than the other groups (p<0.01). The diagnosis of Idiopathic Pulmonary Fibrosis was predominant in all groups except the no revascularization group. The pre-CABG group had a higher portion of single LTx procedures (p 0.014). Kaplan-Meier analysis showed no significantly different survival rates after post-LTx between the groups (p 0.471). Cox Regression analysis showed diagnosis significantly impacted survival rates (p 0.009).<br /><b>Conclusions</b><br />Preoperative or intraoperative revascularization did not affect survival outcomes in lung transplant patients. Selected patients with coronary artery disease may benefit when intervened during lung transplant procedures.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 13 May 2023; epub ahead of print</small></div>
Tran T, Kashem MA, Firoz A, Yanagida R, Shigemura N, Toyoda Y
J Heart Lung Transplant: 13 May 2023; epub ahead of print | PMID: 37187320
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<div><h4>Intermediate-term Outcomes of Complement Inhibition for Prevention of Antibody-Mediated Rejection in Immunologically High-risk Heart Allograft Recipients.</h4><i>Coutance G, Kobashigawa JA, Kransdorf E, Loupy A, ... Kittleson M, Patel JK</i><br /><AbstractText>Allosensitization represents a major barrier to heart transplantation (HTx). We previously reported favorable 1-year outcomes of complement inhibition at transplant in highly sensitized recipients. We now report a longer follow-up. In this single-arm trial (NCT02013037), 20 patients with panel reactive antibodies ≥70% and pre-formed donor-specific antibodies received eculizumab during the first two months post-transplant. The primary endpoint was antibody-mediated rejection (AMR) ≥pAMR2 and/or left ventricular dysfunction. Median follow-up was 4.8 years. Beyond the first year post-transplant, there were no episodes of pAMR2 or greater and no LV dysfunction. There were three deaths, one episode of pAMR1, and one patient with minimal de novo cardiac allograft vasculopathy. Compared to a matched-control group, we observed a non-statistically significant benefit of eculizumab with a lower incidence of primary endpoint or death (primary endpoint: HR=0.50, 95%CI=0.15-1.67, p=0.26; mortality: HR=0.51, 95%CI=0.13-2.07, p=0.35). Our results support the utility of complement inhibition for high-immunological risk recipients. DATA AVAILABILITY STATEMENT: The data that support the findings of this study are available from the corresponding author upon reasonable request.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 12 May 2023; epub ahead of print</small></div>
Coutance G, Kobashigawa JA, Kransdorf E, Loupy A, ... Kittleson M, Patel JK
J Heart Lung Transplant: 12 May 2023; epub ahead of print | PMID: 37182818
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<div><h4>Use of Exception Status Listing and Related Outcomes During Two Heart Allocation Policy Periods.</h4><i>Golbus JR, Ahn YS, Lyden GR, Nallamothu BK, ... Walsh MN, Colvin M</i><br /><b>Background</b><br />The October 2018 update to the heart allocation policy was intended to decrease exception status requests, whereby candidates are listed at a specific status due to perceived need despite not meeting pre-specified criteria of illness severity. We assessed use of exception status and waitlist outcomes before and after the 2018 policy.<br /><b>Methods</b><br />We used data from the Scientific Registry of Transplant Recipients on adult heart transplant candidates listed from 2015-2021. We assessed (1) use of exception status across patient characteristics between the two periods and (2) transplant rate and waitlist mortality or delisting due to deterioration in each period. Patients listed by exception versus standard criteria were compared with multivariable logistic regression and waitlist outcomes assessed using Cox proportional hazards models with medical urgency and exception status as time-dependent covariates.<br /><b>Results</b><br />During the study period (n=19,213), heart transplants under exception status increased post-policy, from 10.0% to 32.3%, with 20.6% of transplants performed for patients at status 2 exception. Exception status candidates post-policy were more frequently Black or Hispanic/Latino, less likely to have hypertrophic or restrictive cardiomyopathy, and had worse hemodynamics. Exception status listing was associated with higher transplant rates in both periods. Post-policy, candidates listed status 1 exception had a lower likelihood for waitlist mortality or delisting (HR, 0.60; 95% CI, 0.37-0.99; P=0.05).<br /><b>Conclusions</b><br />Under the 2018 policy, exception status listings dramatically increased. The policy change shifted the population of patients listed by exception status and affected waitlist mortality, which suggests a need to further evaluate the policy\'s impact.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 12 May 2023; epub ahead of print</small></div>
Golbus JR, Ahn YS, Lyden GR, Nallamothu BK, ... Walsh MN, Colvin M
J Heart Lung Transplant: 12 May 2023; epub ahead of print | PMID: 37182819
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<div><h4>New OPTN/UNOS Data Demonstrates Higher than Previously Reported Waitlist Mortality for Lung Transplant Candidates Supported with ECMO.</h4><i>Lehr CJ, Schold JD, Arrigain S, Valapour M</i><br /><b>Background</b><br />Use of extracorporeal membrane oxygenation (ECMO) is not currently incorporated into US allocation models due to the historical lack of complete data in the national US registry which changed in 2016 to include ECMO at the time of waitlist removal and more granular timing and configuration data.<br /><b>Methods</b><br />We studied adult lung transplant candidates from 01 May 2016 to 01 June 2020 with data abstracted from multiple sources in the US Scientific Registry of Transplant Recipients. Waitlist analyses included cumulative incidence functions and Cox proportional hazards (PH) models considering ECMO as a time-dependent variable. Post-transplant analyses included Kaplan Meier, Cox PH models, and observed to expected survival ratios.<br /><b>Results</b><br />A total of 867 candidates were on ECMO prior to transplant; 247 were identified using new sources of data. Candidates on ECMO had a 23.9 increased adjusted likelihood of waitlist removal for being too sick or death, but only a 4.08 increased adjusted likelihood of transplant. Candidates bridged with ECMO who underwent lung transplant (N=587) experienced an increased overall hazard of post-transplant mortality with veno-arterial and veno-venous configurations conferring HR = 1.67 (95% CI, 1.16, 2.40), HR = 1.45 (95% CI, 1.15, 1.82), respectively.<br /><b>Conclusions</b><br />We identified an additional 28.5% of candidates bridged with ECMO prior to transplant using new data. This study of the newly identified full cohort of ECMO candidates demonstrates higher utilization of ECMO as well as an underestimation of waitlist mortality risk factors that should inform strategies to provide timely access to transplant for this population.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 05 May 2023; epub ahead of print</small></div>
Lehr CJ, Schold JD, Arrigain S, Valapour M
J Heart Lung Transplant: 05 May 2023; epub ahead of print | PMID: 37150472
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<div><h4>Three year post heart transplant outcomes of desensitized durable mechanical circulatory support patients.</h4><i>Youn JC, Kim D, Jung MH, Kim JJ, ... Esmailian F, Kobashigawa JA</i><br /><b>Background</b><br />The risk and benefit of desensitization therapy (DST) in highly sensitized mechanical circulatory support (MCS) patients are not well known. We investigated three year post-transplant outcome of desensitized durable MCS patients.<br /><b>Methods</b><br />Among 689 consecutively enrolled HTx recipients between 2010 and 2016, we categorized them into Group A (desensitized MCS patients, n = 21), Group B (desensitized non-MCS patients, n = 28) and Group C (all non-desensitized patients, n = 640). Post-transplant outcomes included the incidence of primary graft dysfunction (PGD), 3-year survival, freedom from cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), any treated rejection (ATR), acute cellular rejection (ACR), antibody mediated rejection (AMR) and infectious complications.<br /><b>Results</b><br />The types of DST in Groups A and B were similar and included combinations of rituximab/IVIG and plasmapheresis/bortezomib. Group A, compared with Group B, showed significantly higher pre-DST PRA (92.2 ± 9.8 vs. 83.3 ± 15.6, P = 0.007) and higher PRA reduction after DST (-22.2 ± 26.9 vs. -6.3 ± 7.5, P = 0.015). Groups A and C showed comparable PGD, 3-year survival, freedom from CAV, NF-MACE, ATR, ACR and AMR. Although statistically not significant, Group A showed a numerically higher 3-year freedom from AMR than Group B. Infectious complications were similar in both Groups A and B.<br /><b>Conclusions</b><br />DST for MCS patients showed significant PRA reduction, resulting in an expansion of the donor pool. Post-transplant outcome of desensitized MCS patients showed comparable clinical outcome to non-desensitized control patients in the same study period, revealing the safety and efficacy of DST.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 05 May 2023; epub ahead of print</small></div>
Youn JC, Kim D, Jung MH, Kim JJ, ... Esmailian F, Kobashigawa JA
J Heart Lung Transplant: 05 May 2023; epub ahead of print | PMID: 37150473
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<div><h4>Clinical Outcomes of Ventricular Assist Device Support by HIV Infection Status: An STS-Intermacs Analysis.</h4><i>Birk SE, Baran DA, Campbell R, Herre JM, Sadatsafavi H, Yehya A</i><br /><b>Background</b><br />Cardiovascular disease remains the leading cause of mortality in human immunodeficiency virus-infected (HIV-positive) patients. Ventricular assist device therapy is rarely offered to these patients and data on outcomes is sparse.<br /><b>Objectives</b><br />We investigated outcomes following ventricular assist device implant for HIV-positive as compared to non-HIV infected (HIV-negative) patients.<br /><b>Methods</b><br />We analyzed 22,065 patients from the Interagency Registry for Mechanically Assisted Circulatory Support registry for outcomes by HIV status. A propensity-matched analysis adjusting for 21 pre-implant risk factors was also conducted.<br /><b>Results</b><br />Compared with 21,980 HIV-negative device recipients, the 85 HIV-positive recipients were younger (median age 58 years vs. 59 years, p = 0.02), had lower BMI (26 kg/m<sup>2</sup> vs 29 kg/m<sup>2</sup>, p = 0.001), and had higher rates of prior stroke (8% vs 4%, p=0.02). In the matched HIV-positive and HIV-negative cohorts, there was significantly higher mortality in HIV-positive patients in earlier implant years, however this association was not seen in later implant years (2018-2020). In both unmatched and matched cohorts, no significant differences in post-implantation stroke, major bleeding, or major infection were noted.<br /><b>Conclusions</b><br />With recent advancements in mechanical circulatory support and HIV treatment, ventricular assist device therapy is a viable therapeutic option for HIV-positive patients with end stage heart failure.<br /><br />Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 03 May 2023; epub ahead of print</small></div>
Birk SE, Baran DA, Campbell R, Herre JM, Sadatsafavi H, Yehya A
J Heart Lung Transplant: 03 May 2023; epub ahead of print | PMID: 37146667
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<div><h4>Presence and Impact of Anemia in Patients Supported with Left Ventricular Assist Devices.</h4><i>Tie H, Li T, Huang B, Mariani S, ... Lorusso R, Dan C</i><br /><b>Background</b><br />Data on anemia and its effects on patients supported with continuous flow left ventricular assist devices (LVADs) are lacking.<br /><b>Objectives</b><br />This study sought to describe the presence of anemia over time and investigate its association with mortality, quality of life, exercise capacity, and adverse events in LVAD patients.<br /><b>Methods</b><br />Adults receiving durable LVADs between 2008 and 2017 were identified from the INTERMACS database. The full cohort was stratified according to anemia severity (no anemia, mild, moderate-severe).<br /><b>Results</b><br />The analysis of 19,509 patients [females:21.2%, age:56.9±12.9 years] showed that moderate-severe anemia affected 45.2% of patients at baseline, 33.5% of them at 6 months and 32.3% in the fourth year after implantation. The presence of normal hemoglobin was 24.4% before surgery, 32.5% at 6 months and 36.6% at 4 years after implantation. Multivariable linear mixed-effect regression revealed that the average hemoglobin over time was significantly lower (β, -0.233, 95%CI: -0.282 to -0.185), and the reduction of hemoglobin over time was bigger (β, -0.032 95%CI: -0.035 to -0.028) for LVAD non-survivors when compared with LVAD survivors. Adjusted Cox regression showed that the severity of pre-implant anemia was associated with higher mortality (HR, mild: 1.19; 95%CI: 1.05 to 1.35 and moderate-severe: 1.44; 95%CI: 1.28 to 1.62), with similar results in competing risk regression. Anemia progression during follow-up was associated with decreased Kansas City Cardiomyopathy Questionnaire scores and shorter six-minute walk distances.<br /><b>Conclusions</b><br />In patients supported with LVADs, anemia is a frequent comorbidity and deterioration over time is associated with poor prognosis.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 29 Apr 2023; epub ahead of print</small></div>
Tie H, Li T, Huang B, Mariani S, ... Lorusso R, Dan C
J Heart Lung Transplant: 29 Apr 2023; epub ahead of print | PMID: 37127070
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Abstract
<div><h4>Effects of inhaled nitric oxide on Fontan hemodynamics in adults.</h4><i>Miranda WR, Charles Jain C, Frantz RP, DuBrock HM, ... Burchill LJ, Egbe AC</i><br /><AbstractText>The pulmonary vasculature plays a pivotal role in the non-pulsatile systemic venous return post-Fontan palliation. Elevated pulmonary vascular resistance index (PVRi) carries a worse prognosis post-Fontan, but the benefits of pulmonary vasodilators remain controversial. Moreover, the potential for worsening ventricular filling pressures with pulmonary vasodilation has been highlighted. We reviewed our experience with inhaled nitric oxide (iNO) administration during cardiac catheterization in 30 adults (age 32.7±8.5 years) post-Fontan. The main findings of the study are: 1) iNO decreased pulmonary artery pressures, transpulmonary gradient, and PVRi without increasing pulmonary artery wedge pressure (PAWP); 2) cardiac index was unchanged with iNO; 3) different than acquired left heart disease, iNO did not result in further elevations in PAWP in those with elevated ventricular filling pressures. iNO administration in adults post-Fontan was safe; whether baseline PVRi and response to iNO could be used to predict response to pulmonary vasodilators post-Fontan requires further investigation.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 29 Apr 2023; epub ahead of print</small></div>
Miranda WR, Charles Jain C, Frantz RP, DuBrock HM, ... Burchill LJ, Egbe AC
J Heart Lung Transplant: 29 Apr 2023; epub ahead of print | PMID: 37127071
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<div><h4>Risk of Prolonged Ischaemic Time linked to use of Cardio-Pulmonary Bypass during Implantation for Lung Transplantation in the United Kingdom.</h4><i>Mehew JD, Hogg R, Clark S, Santhanakrishnan K, ... Stock U, Dark J</i><br /><b>Background</b><br />Some degree of ischaemia is inevitable in organ transplantation and for most, if not all organs, there is a relationship between ischaemic time and transplant outcome. The contribution of ischaemic time to lung injury is unclear, with conflicting recent data. In this study we investigate the impact of ischemia time upon survival after lung transplantation, in a large national cohort.<br /><b>Methods</b><br />We studied the outcomes for 1565 UK adult lung transplants over a 12-year period, for whom donor, transplant and recipient data were available from the UK Transplant Registry. We examined the effect of ischaemia time (defined as donor cross clamp to recipient reperfusion) and whether standard cardiopulmonary bypass was used using cox proportional hazards models, adjusting for other risk factors.<br /><b>Results</b><br />Total ischaemic time increased from a median under 5 hours in 2003 to over 6.2 hours in 2013. Our findings show that when cardiopulmonary bypass was used, there was an increase in the hazard of death (of 13% (95% CI: 5%-21%) for one-year patient survival) for each hour of total ischaemic time. However, if the cardiopulmonary bypass was not used for implantation, this link disappeared - there was no statistically significant change in mortality with increasing ischaemic time.<br /><b>Conclusions</b><br />We document that avoidance of bypass may remove ischaemic time, within the limits of our observed range of ischaemic times, as a risk factor for poor outcome. Our data, adds to the evidence that bypass may be harmful to the donor lung.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 29 Apr 2023; epub ahead of print</small></div>
Mehew JD, Hogg R, Clark S, Santhanakrishnan K, ... Stock U, Dark J
J Heart Lung Transplant: 29 Apr 2023; epub ahead of print | PMID: 37127072
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<div><h4>Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients.</h4><i>Stöhr EJ, Ji R, Mondellini G, Braghieri L, ... McDonnell BJ, Colombo PC</i><br /><b>Background</b><br />Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the \'artificial pulse\' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the \'artificial pulse\' on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known.<br /><b>Methods</b><br />The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs - representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n=32; heart failure (HF), n=43; HeartMate II (HMII), n=32; HM3, n=41.<br /><b>Results</b><br />In HM3 patients, 2D-Doppler PI in beats with \'artificial pulse\' and beats with \'continuous-flow\' was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with \'artificial pulse\') and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r<sup>2</sup>=0.51, P<0.0001; HM3 \'continuous-flow\', r<sup>2</sup>=0.32, P=0.0009; HM3 \'artificial pulse\', r<sup>2</sup>=0.23, P=0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients.<br /><b>Conclusions</b><br />The \'artificial pulse\' of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 23 Apr 2023; epub ahead of print</small></div>
Stöhr EJ, Ji R, Mondellini G, Braghieri L, ... McDonnell BJ, Colombo PC
J Heart Lung Transplant: 23 Apr 2023; epub ahead of print | PMID: 37098374
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<div><h4>Heart Retransplant Recipients with Chronic Kidney Disease Benefit from Simultaneous Heart-Kidney Transplantation.</h4><i>Malas J, Chen Q, Emerson D, Megna D, ... Bowdish M, Esmailian F</i><br /><b>Background</b><br />Given ongoing donor shortages, appropriate patient selection for dual-organ transplantation is critical. We evaluated outcomes of heart retransplant with simultaneous kidney transplant (HRT-KT) versus isolated heart retransplant (HRT) across varying levels of renal dysfunction.<br /><b>Methods</b><br />The United Network for Organ Sharing database identified 1189 adult patients undergoing heart retransplantation between 2005 and 2020. Recipients undergoing HRT-KT (n=251) were compared to those undergoing HRT (n=938). The primary outcome was five-year survival; subgroup analyses and multivariable adjustment were performed utilizing the following three estimated glomerular filtration (eGFR) groups: < 30mL/min/1.73m<sup>2</sup>, 30-45mL/min/1.73m<sup>2</sup>, and > 45mL/min/1.73m<sup>2</sup>.<br /><b>Results</b><br />HRT-KT recipients were older and had longer waitlist times, longer inter-transplant periods, and lower eGFR levels. HRT-KT recipients were less likely to require pre-transplant ventilator (1.2% vs. 9.0%, p<0.001) or ECMO (2.0% vs. 8.3%, p<0.001) support but were more likely to have severe functional limitation (63.4% vs. 52.6%, p=0.001). After retransplantation, HRT-KT recipients had less treated acute rejection (5.2% vs 9.3%, p=0.02) and more dialysis requirement (29.1% vs. 20.2%, p < 0.001) before discharge. Survival at 5-years was 69.1% after HRT and 80.5% after HRT-KT (p<0.001). After adjustment, HRT-KT was associated with improved 5-year survival among recipients with eGFR < 30 ml/min/1.73m<sup>2</sup> (HR:0.42, 95% CI: 0.26-0.67) and 30-45 ml/min/1.73m<sup>2</sup> (HR:0.29, 95% CI 0.13-0.65), but not among those with eGFR>45 ml/min/1.73sm<sup>2</sup> (HR 0.68, 95% CI 0.30-1.54).<br /><b>Conclusion</b><br />Simultaneous kidney transplantation is associated with improved survival following heart retransplantation in patients with eGFR < 45mL/min/1.73m<sup>2</sup> and should be strongly considered to optimize organ allocation stewardship.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 23 Apr 2023; epub ahead of print</small></div>
Malas J, Chen Q, Emerson D, Megna D, ... Bowdish M, Esmailian F
J Heart Lung Transplant: 23 Apr 2023; epub ahead of print | PMID: 37098375
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<div><h4>The Impact of Thoracoabdominal Normothermic Regional Perfusion on Early Outcomes in Donation After Circulatory Death Lung Transplantation.</h4><i>Malas J, Chen Q, Thomas J, Emerson D, ... Chikwe J, Catarino P</i><br /><AbstractText>Thoracoabdominal normothermic regional perfusion has emerged as an alternative method to procure donation after circulatory death (DCD) hearts, but its impact on concomitantly procured lung allografts remains unclear. The United Network for Organ Sharing database identified 627 DCD donors whose hearts were procured (211 in-situ perfused, 416 directly procured) between 12/2019 - 12/2022. Lung utilization rates were 14.9% (63/422) for in-situ perfused donors and 13.8% (115/832) for directly procured donors (p=0.80). Following transplantation, lung recipients from in-situ perfused donors required numerically lower rates of extracorporeal membrane oxygenation (7.7% vs. 17.0%, p=0.26) and mechanical ventilation (34.6% vs. 47.2%, p=0.29) at 72 hours. Six-month post-transplant survival was similar between groups (85.7% vs. 89.1%, p=0.67). These results suggest that the use of thoracoabdominal normothermic regional perfusion in DCD heart procurement may not adversely impact recipients of concomitantly procured lung allografts.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 23 Apr 2023; epub ahead of print</small></div>
Malas J, Chen Q, Thomas J, Emerson D, ... Chikwe J, Catarino P
J Heart Lung Transplant: 23 Apr 2023; epub ahead of print | PMID: 37098376
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<div><h4>Caregiver burden before heart transplantation and long-term mechanical circulatory support: Findings from the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) study.</h4><i>Okwuosa IS, Anderson AS, Petty M, Wu T, ... Kirklin JK, Grady KL</i><br /><b>Background</b><br />Caregiving for heart failure (HF) patients is burdensome. We examined differences in caregiver burden for three groups of older advanced HF patients: (1) supported with mechanical circulatory support (MCS) before heart transplantation (HT MCS), (2) awaiting transplant without MCS (HT non-MCS), and (3) prior to long-term MCS and factors associated with burden.<br /><b>Methods</b><br />From 10/1/15-12/31/18, we enrolled 276 caregivers for HF patients from 13 U.S. sites: 85 HT MCS, 96 HT non-MCS, and 95 prior to long-term MCS. At enrollment, caregivers completed the Oberst Caregiving Burden Scale (15 items, 2 subscales: time (range=1-5; higher score=more time spent on task) and difficulty (range=1-5; higher score=higher difficulty of task) and other measures. Statistical analyses included descriptive statistics, ANOVA, chi-square tests, and linear regression.<br /><b>Results</b><br />Overall, caregivers were aged 60.8±9.8 years and predominantly white, female, spouses, well educated, and reported ≥1 comorbidities. Caregivers overall reported a moderate amount of time spent on tasks and slight task difficulty. Caregivers for HT non-MCS candidates reported significantly less perceived time spent on tasks than caregivers for HT MCS candidates and caregivers for patients prior to long-term MCS (2.2±0.74 vs 2.4±0.74 vs 2.5±0.71, respectively, p=0.02) and less perceived difficulty of tasks (1.2±0.33 vs 1.4±0.53 vs 1.4±0.54, respectively, p=0.01). Caregiver and patient factors were associated with caregiver burden.<br /><b>Conclusions</b><br />Prior to HT and long-term MCS, caregiver burden was low to moderate. Caregiver factors were predominantly associated with caregiver burden. Understanding caregiver burden and factors affecting caregiver burden may enhance preoperative advanced therapies discussions and guide caregiver support.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 21 Apr 2023; epub ahead of print</small></div>
Okwuosa IS, Anderson AS, Petty M, Wu T, ... Kirklin JK, Grady KL
J Heart Lung Transplant: 21 Apr 2023; epub ahead of print | PMID: 37088337
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<div><h4>Body Mass Index Percentage and Survival in Pediatric Patients Listed for Lung Transplantation: A Modern-Era Multi-Institutional Analysis.</h4><i>Heidel JS, Dani A, Towe C, Schecter M, ... Morales DLS, Hayes D</i><br /><b>Background</b><br />Prior studies suggest that being underweight by body mass index percentiles (BMI%) or thinness grade did not affect post-transplant survival in pediatric lung transplant (LTx) recipients regardless of cystic fibrosis (CF) or non-CF diagnosis. Graft and overall survival from the time of listing was instead evaluated based on listing BMI%, the current standard of practice for BMI definitions in pediatrics, to ascertain the impact of a \"severely low\" subcategory.<br /><b>Methods</b><br />The UNOS registry was queried for children listed for LTx (aged 2 to <18 years) from January 1986 to March 2020. BMI% at listing and transplant were calculated per CDC guidelines according to age in years, sex, and reported BMI%. Patients were divided by listing BMI%: severely low (<3<sup>rd</sup>), low (3-<5<sup>th</sup>), normal (5-<85<sup>th</sup>), overweight (85-<95<sup>th</sup>), and obese (≥95<sup>th</sup>). Kaplan-Meier curves were generated to assess differences in overall survival since listing based on BMI% classes. Cox proportional-hazards models were developed to assess risk factors for overall and graft survival, including listing BMI%, transplant listing era (≥2005), and listing age, by reporting hazard ratios (HR).<br /><b>Results</b><br />Listing BMI% was calculable for 1,876 patients. The proportion of patients with CF differed significantly between BMI% groups (p<0.001). Patients listed with a non-CF diagnosis comprised 34% of those in the severely low category, and 88% of those listed with an obese BMI%. Compared to patients with a normal listing BMI%, the cohort with severely low BMI% had worse overall survival regardless of LTx (p=0.009) and graft survival (p=0.034). Compared to patients with a low BMI%, those with a severely low BMI% had significantly poorer graft survival as well (p=0.040). Mean graft survival was not significantly different between groups that remained at listing BMI% versus those that improved in category despite an overall small sample size. Independent predictors of poorer survival from the time of listing include severely low vs low-normal BMI% (HR=1.20) and listing age (HR=1.02).<br /><b>Conclusion</b><br />The proportion of children listed at severely low BMI% has steadily decreased with time, yet pediatric LTx candidates listed with a severely low BMI% had poorer graft and overall survival compared to those of normal BMI%. Severely low listing BMI% was an independent prognostic factor for higher mortality risk from the time of placement on the waitlist. BMI% may be a modifiable target for improving survival regardless of transplantation.<br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 21 Apr 2023; epub ahead of print</small></div>
Heidel JS, Dani A, Towe C, Schecter M, ... Morales DLS, Hayes D
J Heart Lung Transplant: 21 Apr 2023; epub ahead of print | PMID: 37088338
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<div><h4>Risk factors and prognosis of airway complications in lung transplant recipients: A systematic review and meta-analysis.</h4><i>Huang J, Lin J, Zheng Z, Liu Y, ... Zhong C, Li S</i><br /><b>Background</b><br />Airway complications (AC) are one of leading causes of morbidity and mortality after lung transplant (LTx), but their predictors and outcomes remain controversial. This study aimed to identify potential risk factors and prognosis of AC .<br /><b>Methods</b><br />A systematic review was performed by searching PubMed, Embase, and Cochrane Library. All observational studies reporting outcome and potential factors of AC after LTx were included. The incidence, mortality, and estimated effect of each factor for AC were pooled by using the fixed-effects model or random-effects model.<br /><b>Results</b><br />Thirty-eight eligible studies with 52,116 patients undergoing LTx were included for meta-analysis. The pooled incidence of AC was 12.4% (95%Cl: 9.5-15.8) and the mean time of occurrence was 95.6 days. AC-related mortality rates at 30-days, 90-days, 6 months, 1 year, and 5 years were 6.7%, 17.9%, 18.2%, 23.6%, and 66.0%, respectively. Airway dehiscence was the most severe type with a high mortality at 30 days (60.9%, 95%Cl: 20.6-95.2). We found that AC was associated with a higher risk of mortality in LTx recipients (hazard ratio [HR] 1.71, 95%Cl 1.04-2.81). Eleven significant predictors for AC were also identified, including male donor, male recipient, diagnosis of COPD, hospitalization, early rejection, postoperative infection, extracorporeal membrane oxygenation, mechanical ventilation, telescopic anastomosis, and bilateral and right-sided LTx.<br /><b>Conclusion</b><br />AC was significantly associated with higher mortality after LTx, especially for dehiscence. Targeted prophylaxis for modifiable factors and enhanced early bronchoscopy surveillance after LTx may improve the disease burden of AC.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 21 Apr 2023; epub ahead of print</small></div>
Huang J, Lin J, Zheng Z, Liu Y, ... Zhong C, Li S
J Heart Lung Transplant: 21 Apr 2023; epub ahead of print | PMID: 37088339
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<div><h4>Center Volume Effect on Acute Cellular Rejection and Outcomes in Pediatric Lung Transplant Recipients.</h4><i>Guzman-Gomez A, Ahmed HF, Dani A, Zafar F, ... Ziady AG, Hayes D</i><br /><b>Background</b><br />Acute cellular rejection (ACR) is common after lung transplant (LTx). We sought to determine if transplant center volume affected ACR-related outcomes in children after LTx.<br /><b>Methods</b><br />The United Network for Organ Sharing (UNOS) Registry was queried for patients <18-years-of-age who underwent LTx 1987-2020. Cohorts were children who survived the first-year post transplant and were treated for ACR within that first year (ACR group) and those not treated for ACR (non-ACR). LTx center volume was defined as: high volume center (HVC) (>5LTxs/year), medium volume center (MVC) (>1≤5 LTxs/year), and low volume center (LVC) (≤1LTxs/year).<br /><b>Results</b><br />1320 patients were enrolled into the study; 269 (20.4%) did not experience ACR. The ACR cohort was older (median 14 [11-16] vs 13 [7-16] years, p<0.001), female (65.3% vs 57.3%, p=0.016), cystic fibrosis diagnosis (62.3% vs 45.5%, p<0.001), and higher lung allocation score (37.3 [34.6-47.8] vs 35.8 [33-42.6], p=0.029). The ACR cohort trended (p=0.06) towards lower survival at 5-year (37% vs 47%) and 10-year (25% vs 34%) post-LTx. Among children at HVCs, ACR occurred in 17% of recipients (n=98/574), compared to 18.5% (n=73/395) at MVCs and 27% (n=100/369) at LVCs. Children treated for ACR at HVCs had higher survival than LVCs at 5-years (52% vs 29%) and 10-years (36% vs 15%) (p<0.001) but similar survival to MVCs at 5-years (52% vs 43%) and 10-years (36% vs 24%) (p=0.081). No survival differences were detected in MVCs vs LVCs (p=0.14).<br /><b>Conclusions</b><br />ACR treated within the first post-LTx year influence survival of children. ACR incidence was lowest at higher volume centers whereas post-ACR treatment survival outcomes were also superior.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 21 Apr 2023; epub ahead of print</small></div>
Guzman-Gomez A, Ahmed HF, Dani A, Zafar F, ... Ziady AG, Hayes D
J Heart Lung Transplant: 21 Apr 2023; epub ahead of print | PMID: 37088340
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<div><h4>Racial and Socioeconomic Disparities in Status Exceptions for Pediatric Heart Transplant Candidates under the current U.S. Pediatric Heart Allocation Policy.</h4><i>Wright LK, Culp S, Gajarski RJ, Nandi D</i><br /><b>Background</b><br />The 2016 revision of the US Pediatric Heart Allocation Policy developed stringent rules for priority status creating impetus for clinicians to seek status exceptions. We hypothesized there may be differential status exceptions based on race and socioeconomic status (SES) contributing to disparities in waitlist outcomes.<br /><b>Methods</b><br />The Scientific Registry for Transplant Recipients was queried for children listed for heart transplant from 2012 to 2020. Waitlist status & mortality with regards to race and neighborhood SES were stratified by listing before (Era 1) or after (Era 2) the policy change.<br /><b>Results</b><br />The use of both 1A and 1B exceptions (E) increased in Era 2. In Era 1, there was no association between patient race or neighborhood SES on use of 1A(E) or 1B(E) when controlling for age and diagnosis. In Era 2, neither race nor neighborhood SES were associated with 1A(E), but both were associated with 1B(E): non-Hispanic (NH) Black children and those from low- and middle-SES neighborhoods were significantly less likely to be listed 1B(E). In Era 1, there were no significant differences in waitlist mortality based on race at any waitlist status; in Era 2, NH Black children had higher waitlist mortality when initially listed 1B or 2.<br /><b>Conclusions</b><br />Since the 2016 policy change, racial disparities in waitlist mortality have worsened among children initially listed with lower priority status. Unequal use of 1B exceptions, which lower waitlist mortality, may explain some of these disparities. Recently implemented standardized pediatric exception guidance has the potential to improve equity.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 21 Apr 2023; epub ahead of print</small></div>
Wright LK, Culp S, Gajarski RJ, Nandi D
J Heart Lung Transplant: 21 Apr 2023; epub ahead of print | PMID: 37088341
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<div><h4>Pseudomonas-dominant Microbiome Elicits Sustained IL-1β Upregulation in Alveolar Macrophages from Lung Transplant Recipients.</h4><i>Britton N, Villabona-Rueda A, Whiteside SA, Mathew J, ... Shah P, D\'Alessio F</i><br /><b>Background</b><br />Isolation of Pseudomonas aeruginosa (PsA) is associated with increased BAL (bronchoalveolar lavage) inflammation and lung allograft injury in lung transplant recipients (LTR). However, the effect of PsA on macrophage responses in this population is incompletely understood. We examined human alveolar macrophage (AMΦ) responses to PsA and Pseudomonas dominant microbiome in healthy LTR.<br /><b>Methods</b><br />We stimulated THP-1 derived macrophages (THP-1MΦ) and human AMΦ from LTR with different bacteria and LTR BAL derived microbiome characterized as Pseudomonas-dominant. Macrophage responses were assessed by high dimensional flow cytometry, including their intracellular production of cytokines (TNF-α, IL-6, IL-8, IL-1β, IL-10, IL-1RA, and TGF-β). Pharmacological inhibitors were utilized to evaluate the role of the inflammasome in PsA-macrophage interaction.<br /><b>Results</b><br />We observed upregulation of pro-inflammatory cytokines (TNF-α, IL-6, IL-8, IL-1β) following stimulation by PsA compared to other bacteria (Staphylococcus aureus (S.Aur), Prevotella melaninogenica, Streptococcus pneumoniae) in both THP-1MΦ and LTR AMΦ, predominated by IL-1β. IL-1β production from THP-1MΦ was sustained after PsA stimulation for up to 96 hours and 48 hours in LTR AMΦ. Treatment with the inflammasome inhibitor BAY11-7082 abrogated THP-1MΦ IL-1β production after PsA exposure. BAL Pseudomonas-dominant microbiota elicited an increased IL-1β, similar to PsA, an effect abrogated by the addition of antibiotics.<br /><b>Conclusion</b><br />PsA and PsA-dominant lung microbiota induce sustained IL-1β production in LTR AMΦ. Pharmacological targeting of the inflammasome reduces PsA-macrophage-IL-1β responses, underscoring their use in lung transplant recipients.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 21 Apr 2023; epub ahead of print</small></div>
Britton N, Villabona-Rueda A, Whiteside SA, Mathew J, ... Shah P, D'Alessio F
J Heart Lung Transplant: 21 Apr 2023; epub ahead of print | PMID: 37088343
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<div><h4>Impact of Adverse Events on Health-Related Quality of Life after Left Ventricular Assist Device Implantation - An STS INTERMACS Analysis.</h4><i>Kilic A, Kwon JH, Grady KL, Singletary BA, ... Kirklin JK, Stehlik J</i><br /><b>Background</b><br />We sought to quantify the impact of pre- and post-operative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation.<br /><b>Methods</b><br />Primary durable LVAD implants between 2012-2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and post-implant adverse events (AEs) on HRQOL as assessed by the EQ-5D Visual Analog Scale (VAS) [0 (worst) to 100 (best) health state] at 6 months and 3 years.<br /><b>Results</b><br />Of 22,230 LVAD implants, 9,888 patients had complete VAS data at 6 months, and 2,170 patients at 3 years post-implant. VAS improved from a mean of 38.2±28.3 to 70.7±22.9 at 6 months and from 40.1±27.8 to 70.3±23.1 at 3 years. KCCQ improved from a mean of 28.2±23.9 to 64.3±23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ±23.7 at 3 years. Pre-implant variables, including baseline VAS, had small effect sizes on HRQOL while post-implant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years.<br /><b>Conclusion</b><br />AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 09 Apr 2023; epub ahead of print</small></div>
Kilic A, Kwon JH, Grady KL, Singletary BA, ... Kirklin JK, Stehlik J
J Heart Lung Transplant: 09 Apr 2023; epub ahead of print | PMID: 37040860
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<div><h4>Donor heart ischemic time can be extended to 8 hours using hypothermic machine perfusion in sheep.</h4><i>See Hoe LE, Bassi GL, Wildi K, Passmore MR, ... McGiffin DC, Fraser JF</i><br /><b>Background</b><br />The global shortage of donor hearts available for transplantation is a major problem for the treatment of end-stage heart failure. The ischemic time for donor hearts using traditional preservation by standard static cold storage (SCS) is limited to approximately 4 hours, beyond which the risk for primary graft dysfunction (PGD) significantly increases. Hypothermic machine perfusion (HMP) of donor hearts has been proposed to safely extend ischemic time without increasing the risk of PGD.<br /><b>Methods</b><br />Using our sheep model of 24 hours brain death (BD) followed by orthotopic heart transplantation (HTx), we examined post-transplant outcomes in recipients following donor heart preservation by HMP for 8 hours, compared to donor heart preservation for 2 hours by either SCS or HMP.<br /><b>Results</b><br />Following HTx, all HMP recipients (both 2h and 8h groups) survived to the end of the study (6 hours after transplantation and successful weaning from cardiopulmonary bypass), required less vasoactive support for hemodynamic stability, and exhibited superior metabolic, fluid status and inflammatory profiles compared to SCS recipients. Contractile function and cardiac damage (troponin I release and histological assessment) was comparable between groups.<br /><b>Conclusions</b><br />Overall, compared to current clinical SCS, recipient outcomes following transplantation are not adversely impacted by extending HMP to 8 hours. These results have important implications for clinical transplantation where longer ischemic times may be required (e.g., complex surgical cases, transport across long distances). Additionally, HMP may allow safe preservation of \'marginal\' donor hearts that are more susceptible to myocardial injury and facilitate increased utilisation of these hearts for transplantation.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 07 Apr 2023; epub ahead of print</small></div>
See Hoe LE, Bassi GL, Wildi K, Passmore MR, ... McGiffin DC, Fraser JF
J Heart Lung Transplant: 07 Apr 2023; epub ahead of print | PMID: 37031869
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<div><h4>Detection of inflow obstruction in left ventricular assist devices by accelerometer: A porcine model study.</h4><i>Lilja D, Schalit I, Espinoza A, Fiane AE, ... Elle OJ, Halvorsen PS</i><br /><b>Background</b><br />Left ventricular assist devices (LVAD) provide circulatory blood pump support for severe heart failure patients. Pump inflow obstructions may lead to stroke and pump malfunction. We aimed to verify in vivo that gradual inflow obstructions, representing prepump thrombosis, are detectable by a pump-attached accelerometer, where the routine use of pump power (P<sub>LVAD</sub>) is deficient.<br /><b>Method</b><br />In a porcine model (n=8), balloon-tipped catheters obstructed HVAD™ inflow conduits by 34%-94% in five levels. Afterload increases and speed alterations were conducted as controls. We computed nonharmonic amplitudes (NHA) of pump vibrations captured by the accelerometer for the analysis. Changes in NHA and P<sub>LVAD</sub> were tested by a pairwise nonparametric statistical test. Detection sensitivities and specificities were investigated by receiver operating characteristics with areas under the curves (AUC).<br /><b>Results</b><br />NHA remained marginally affected during control interventions, unlike P<sub>LVAD</sub>. NHA elevated during obstructions within 52-83%, while mass pendulation was most pronounced. Meanwhile, P<sub>LVAD</sub> changed far less. Increased pump speeds tended to amplify the NHA elevations. The corresponding AUC was 0.85-1.00 for NHA and 0.35-0.73 for P<sub>LVAD</sub>.<br /><b>Conclusion</b><br />Elevated NHA provides a reliable indication of subclinical gradual inflow obstructions. The accelerometer can potentially supplement P<sub>LVAD</sub> for earlier warnings and localization of pump thrombosis.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 04 Apr 2023; epub ahead of print</small></div>
Lilja D, Schalit I, Espinoza A, Fiane AE, ... Elle OJ, Halvorsen PS
J Heart Lung Transplant: 04 Apr 2023; epub ahead of print | PMID: 37023840
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<div><h4>Fifth bivalent omicron BA.4/BA.5 vaccination neutralization of SARS-CoV-2 in heart transplant recipients.</h4><i>Peled Y, Afek A, Patel JK, Raanani E, ... Elkader BA, Mandelboim M</i><br /><AbstractText>In 2022, the antigenically divergent SARS-CoV-2 omicron variants (BA.1, BA.2, BA.4, BA.5) outcompeted previous variants and continued to cause substantial numbers of illnesses and deaths. We evaluated the safety and immunogenicity of the bivalent original/omicron BA.4/BA.5 Pfizer/BioNTech vaccine administered as a fifth dose to heart transplant recipients (HTxRs). We compared neutralization (using live virus assays) of SARS-CoV-2-infected cells in serum samples from HTxRs who had previously received 4 doses of the monovalent BNT162b2 vaccine with samples from HTxRs with breakthrough infection after 4 monovalent BNT162b2 doses. The fifth vaccination induced high neuralization efficiency against the wild-type virus and omicron BA.1, BA.2, BA.4 and BA.5 variants, with significantly higher neutralization efficiency being induced in HTxRs with breakthrough infection than in those without. Neutralizing titers in those with breakthrough infection were sustained above the level induced by the fifth dose in the uninfected. We conclude that the fifth bivalent vaccine is immunogenic, including to variants, with higher vaccine immunogenicity conferred by breakthrough infection. Nevertheless, the clinical protection conferred by the fifth dose is yet to be determined. The sustained neutralization responses in those with breakthrough infection support the notion of delaying booster in those with natural breakthrough infection.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 29 Mar 2023; epub ahead of print</small></div>
Peled Y, Afek A, Patel JK, Raanani E, ... Elkader BA, Mandelboim M
J Heart Lung Transplant: 29 Mar 2023; epub ahead of print | PMID: 37084801
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<div><h4>Treatment Effects of Pulmonary Artery Denervation for Pulmonary Arterial Hypertension Stratified by REVEAL Risk Score: Results from PADN-CFDA Trial.</h4><i>Zhang J, Kan J, Wei Y, Zhang C, ... Stone GW, Chen SL</i><br /><b>Background</b><br />The differential treatment effect of pulmonary artery denervation (PADN) in pulmonary arterial hypertension (PAH) patients with different risk burdens remains unclear. This study aimed to determine the effectiveness of PADN in low vs. intermediate-high-risk PAH patients.<br /><b>Methods</b><br />In total, 128 patients with treatment naive PAH included in the PADN-CFDA trial were categorized into low-risk and intermediate-high-risk patients. The primary endpoint was the between-group difference in the change in 6-minute walk distance (6 MWD) from baseline to 6 months.<br /><b>Results</b><br />In the intermediate-high-risk group, those treated with PADN and PDE-5i had a greater improvement in 6 MWD from baseline to 6 months as compared to those treated with sham plus PDE-5i. From baseline to 6 months, pulmonary vascular resistance (PVR) was reduced by -6.1±0.6 and -2.0 ± 0.7 Wood units following PADN plus PDE-5i and sham plus PDE-5i, respectively, along with the significant reduction of NT-proBNP in the intermediate-high-risk group. However, there were no significant differences in 6 MWD, PVR, and NT-proBNP between the PADN plus PDE-5i and sham plus PDE-5i groups among low-risk patients. Moreover, the right ventricular function was equally improved by PADN treatment across the low-, intermediate-, and high-risk groups. Clinical worsening was less with PADN plus PDE-5i treatment during the 6-month follow-up.<br /><b>Conclusions</b><br />In patients with PAH, PADN plus PDE-5i improved exercise capacity, NT-proBNP, hemodynamic, and clinical outcomes during the 6-month follow-up among intermediate-high risk patients.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 27 Mar 2023; epub ahead of print</small></div>
Zhang J, Kan J, Wei Y, Zhang C, ... Stone GW, Chen SL
J Heart Lung Transplant: 27 Mar 2023; epub ahead of print | PMID: 36990173
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<div><h4>Withdrawing Extra Corporeal Membrane Oxygenation (ECMO) Against a Family\'s Wishes: Three Permissible Scenarios.</h4><i>Bibler TM, Zainab A</i><br /><AbstractText>The ethical permissibility of unilaterally withdrawing life-sustaining technologies has been a perennial topic in transplant and critical care medicine, often focusing on CPR and mechanical ventilation. The permissibility of unilateral withdrawal of extracorporeal membrane oxygenation (ECMO) has been discussed sparingly. When addressed, authors have appealed to professional authority rather than substantive ethical analysis. In this Perspective, we argue that there are at least three (3) scenarios wherein healthcare teams would be justified in unilaterally withdrawing ECMO, despite the objections of the patient\'s legal representative. The ethical considerations that provide the groundwork for these scenarios are, primarily: equity, integrity, and the moral equivalence between withholding and withdrawing medical technologies. First, we place equity in the context of crisis standards of medicine. After this, we discuss professional integrity as it relates to the innovative usage of medical technologies. Finally, we discuss the ethical consensus known at the \"equivalence thesis.\" Each of these considerations include a scenario and justification for unilateral withdrawal. We also provide three (3) recommendations that aim at preventing these challenges at their outset. Our conclusions and recommendations are not meant to be blunt arguments that ECMO teams wield whenever disagreement about the propriety of continued ECMO support arises. Instead, the onus will be on individual ECMO programs to evaluate these arguments and decide if they represent sensible, correct, and implementable starting points for clinical practice guidelines or policies.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 25 Mar 2023; epub ahead of print</small></div>
Bibler TM, Zainab A
J Heart Lung Transplant: 25 Mar 2023; epub ahead of print | PMID: 36972748
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<div><h4>Pulmonary epithelial markers in phenotypes of chronic lung allograft dysfunction.</h4><i>Levy L, Moshkelgosha S, Huszti E, Hunter S, ... Tikkanen J, Martinu T</i><br /><b>Background</b><br />Airway epithelial injury is thought to be a key event in the pathogenesis of chronic lung allograft dysfunction (CLAD). We investigated whether markers of epithelial activity and injury in bronchoalveolar lavage fluid (BAL) correlate with CLAD diagnosis and major CLAD phenotypes: bronchiolitis obliterans syndrome (BOS) vs. restrictive allograft syndrome (RAS)-related phenotypes (including RAS, mixed phenotype, and all other patients with RAS-like opacities).<br /><b>Methods</b><br />CLAD status and phenotypes were retrospectively determined in a cohort of all consecutive adult, first, bilateral lung transplants performed 2010-2015, with available BAL samples. All patients with RAS-related phenotypes were included and 1:1 matched with BOS patients based on the time from transplant to CLAD-onset. Subjects who were CLAD-free for a minimum of 3 years post-transplant were 1:1 matched to CLAD patients and included as controls. Proteins that maintain the barrier function of the airway epithelial mucosa (club cell secretory protein (CCSP), surfactant protein-D (SP-D) and epithelial mucins: MUC1, MUC5AC, MUC5B, MUC16), as well as epithelial cell death markers (M30&M65 representing epithelial cell apoptosis and overall death, respectively), were measured in BAL obtained within 6-months post CLAD onset using a double-sandwich ELISA or a multiplex bead assay. Protein levels were compared using Mann-Whitney-U-test. Association between protein levels and graft survival was assessed using Cox proportional hazards models, adjusted for CMV serology mismatch status and CLAD phenotype.<br /><b>Results</b><br />Fifty-four CLAD (27 BOS, 11 RAS, 7 mixed, 9 others with RAS-like opacities) patients and 23 CLAD-free controls were included. Median BAL levels were significantly higher in patients with CLAD compared to CLAD-free controls for M30 (124.5 vs. 88.7 U/L), MUC1 (6.8 vs. 3.2 pg/mL), and MUC16 (121.0 vs. 30.1 pg/mL). When comparing CLAD phenotypes, M30 was significantly higher in patients with RAS-related phenotypes than BOS (160.9 vs. 114.6 U/L). In multivariable models, higher M30 and MUC5B levels were associated with decreased allograft survival after CLAD onset independent of phenotype (P<0.05 for all).<br /><b>Conclusion</b><br />Airway epithelial mucins and cell death markers are enhanced in the BAL of patients with CLAD and can assist in differentiating between CLAD phenotypes and post-CLAD outcomes. Abnormal airway mucin expression and epithelial cell death may be involved in the pathogenesis of CLAD, and therefore their detection may aid in future selection of targeted therapies.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 22 Mar 2023; epub ahead of print</small></div>
Levy L, Moshkelgosha S, Huszti E, Hunter S, ... Tikkanen J, Martinu T
J Heart Lung Transplant: 22 Mar 2023; epub ahead of print | PMID: 36963446
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<div><h4>Endothelial Protection in Lung Grafts through Heparanase Inhibition During Ex Vivo Lung Perfusion in Rats.</h4><i>Noda K, Philips BJ, Atale N, Sanchez PG</i><br /><b>Objective</b><br />We hypothesized that enhancing glycocalyx preservation would reduce endothelial damage in lung grafts during ex-vivo lung perfusion (EVLP) leading to better transplant outcomes. In this study, we characterized the effects of inhibiting heparanase (HPSE), an enzyme responsible for glycocalyx shedding, on lung quality during EVLP.<br /><b>Methods</b><br />Human clinical EVLP perfusate from lung graft patients was utilized to identify a potential association between glycocalyx integrity in grafted lung tissue and clinical data. In addition, we performed pre-clinical studies in which rat lungs underwent normothermic EVLP for 4 hours with/without HPSE inhibitors, heparin (1000-U/hour) or heparastatin (SF4; 1-μM), added to the perfusate. After 4-hours EVLP, left lungs were transplanted into syngeneic rats then evaluated for graft quality 2-hours after reperfusion.<br /><b>Results</b><br />Clinically, increased degradation of syndecan-1 was identified in dysfunctional grafts during EVLP. Levels of heparan sulfate in perfusate after EVLP were associated with incidence of graft dysfunction after transplantation. In the pre-clinical rat study, SF4 effectively inhibited HPSE activity, and significantly attenuated dissociated glycocalyx levels, endothelial dysfunction, edema, and inflammation in lungs during EVLP compared to both controls and heparin groups. High-doses of heparin demonstrated markedly increased perfusate syndecan-1 concentrations and deteriorated lung quality during EVLP compared with controls. Post-transplant graft function and inflammation were significantly improved in SF4-treated group compared to those in both control and heparin-treated groups.<br /><b>Conclusion</b><br />This study demonstrated that HPSE activity inhibition by SF4 can improve graft preservation during EVLP by protecting the glycocalyx and endothelial function, leading to better lung function following transplantation.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Heart Lung Transplant: 20 Mar 2023; epub ahead of print</small></div>
Noda K, Philips BJ, Atale N, Sanchez PG
J Heart Lung Transplant: 20 Mar 2023; epub ahead of print | PMID: 36948268
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<div><h4>Mechanical circulatory support in severe primary graft dysfunction: Peripheral cannulation but not earlier implantation improves survival in heart transplantation.</h4><i>Olivella A, Almenar-Bonet L, González-Vilchez F, Díez-López C, ... Muñiz J, González-Costello J</i><br /><b>Background</b><br />Primary graft dysfunction (PGD) still affects 2% to 28% of heart transplants (HT). Severe PGD requires mechanical circulatory support (MCS) and is the main cause of death early after HT. Earlier initiation has been suggested to improve prognosis but the best cannulation strategy is unknown.<br /><b>Methods</b><br />Analysis of all HT in Spain between 2010 and 2020. Early (<3 hours after HT) vs late initiation (≥3 hours after HT) of MCS was compared. Special focus was placed on peripheral vs central cannulation strategy.<br /><b>Results</b><br />A total of 2376 HT were analyzed. 242 (10.2%) suffered severe PGD, 171 (70.7%) received early MCS and 71 (29.3%) late MCS. Baseline characteristics were similar. Patients with late MCS had higher inotropic scores and worse renal function at the moment of cannulation. Early MCS had longer cardiopulmonary bypass times and late MCS was associated with more peripheral vascular damage. No significant differences in survival were observed between early and late implant at 3 months (43.82% vs 48.26%; log-rank p = 0.59) or at 1 year (39.29% vs 45.24%, log-rank p = 0.49). Multivariate analysis did not show significant differences favoring early implant. Survival was higher in peripheral compared to central cannulation at 3 months (52.74% vs 32.42%, log-rank p = 0.001) and 1 year (48.56% vs 28.19%, log-rank p = 0.0007). In the multivariate analysis, peripheral cannulation remained a protective factor.<br /><b>Conclusions</b><br />Earlier MCS initiation for PGD was not superior, compared to a more conservative approach with deferred initiation. Peripheral compared to central cannulation showed superior 3-month and 1-year survival rates.<br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 15 Mar 2023; epub ahead of print</small></div>
Olivella A, Almenar-Bonet L, González-Vilchez F, Díez-López C, ... Muñiz J, González-Costello J
J Heart Lung Transplant: 15 Mar 2023; epub ahead of print | PMID: 37019730
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<div><h4>European multicenter study on the real-world use and clinical impact of extracorporeal photopheresis after heart transplantation.</h4><i>Barten MJ, Sax B, Schopka S, Amarelli C, ... Ingram A, Zuckermann A</i><br /><b>Background</b><br />Aim of this study was to describe the real-world use of extracorporeal photopheresis (ECP) and assess its impact on clinical outcomes in the modern era of heart transplantation.<br /><b>Methods</b><br />Seven transplant centers from 5 European countries participated in this retrospective, observational, single-arm chart review study. All patients received ECP after heart transplantation in 2015 or later. Data were extracted from medical records between November 2020 and December 2021.<br /><b>Results</b><br />Overall, 105 patients were enrolled and followed for an average of 2 years after initiation of ECP. Reasons to start ECP were acute cellular rejection (35.2%), rejection prevention (32.4%), mixed rejection (18.1%), and antibody-mediated rejection (14.3%). Rejection ISHLT grades improved from start to end of ECP treatment in 92% of patients treated with ECP for rejection. Of patients who started ECP to prevent rejection, 88% remained free from any rejection despite a reduction of calcineurin inhibitors. Overall survival was 95%, and no deaths were related to ECP. Safety events occurred in 18 patients, of which 13 experienced complications with venous access.<br /><b>Conclusions</b><br />This study, the largest European ECP study in heart transplantation, demonstrates that ECP can effectively be used to treat different rejection types and to prevent rejection in the modern era of immunosuppression. Patients with rejections who have received ECP have shown high response as measured by histological improvements in ISHLT classification. A high percentage of patients in the prevention group remained free from rejection despite reduction in immunosuppression, in particular calcineurin inhibitors.<br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 15 Mar 2023; epub ahead of print</small></div>
Barten MJ, Sax B, Schopka S, Amarelli C, ... Ingram A, Zuckermann A
J Heart Lung Transplant: 15 Mar 2023; epub ahead of print | PMID: 37037751
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<div><h4>Prophylactic epinephrine attenuates severe bleeding in lung transplantation patients undergoing transbronchial lung biopsy: Results of the PROPHET randomized trial.</h4><i>Kalchiem-Dekel O, Tran BC, Glick DR, Ha NT, ... Sachdeva A, Reed RM</i><br /><b>Background</b><br />Severe hemorrhage is an uncommon yet potentially life-threatening complication of transbronchial lung biopsy. Lung transplantation recipients undergo multiple bronchoscopies with biopsy and are considered to be at an increased risk for bleeding from transbronchial biopsy, independent of traditional risk factors. We aimed to evaluate the efficacy and safety of endobronchial administration of prophylactic topical epinephrine in attenuating transbronchial biopsy-related hemorrhage in lung transplant recipients.<br /><b>Methods</b><br />The Prophylactic Epinephrine for the Prevention of Transbronchial Lung Biopsy-related Bleeding in Lung Transplant Recipients study was a 2-center, randomized, double blind, placebo-controlled clinical trial. Participants undergoing transbronchial lung biopsy were randomized to receive 1:10,000-diluted topical epinephrine vs saline placebo administered prophylactically into the target segmental airway. Bleeding was graded based on a clinical severity scale. The primary efficacy outcome was incidence of severe or very severe hemorrhage. The primary safety outcome was a composite of 3-hours all-cause mortality and an acute cardiovascular event.<br /><b>Results</b><br />A total of 66 lung transplantation recipients underwent 100 bronchoscopies during the study period. The primary outcome of severe or very severe hemorrhage occurred in 4 cases (8%) in the prophylactic epinephrine group and in 13 cases (24%) in the control group (p = 0.04). The composite primary safety outcome did not occur in any of the study groups.<br /><b>Conclusions</b><br />In lung transplantation recipients undergoing transbronchial lung biopsy, prophylactic administration of 1:10,000-diluted topical epinephrine into the target segmental airway before biopsy attenuates the incidence of significant endobronchial hemorrhage without conveying a significant cardiovascular risk. (ClinicalTrials.gov identifier: NCT03126968).<br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 14 Mar 2023; epub ahead of print</small></div>
Kalchiem-Dekel O, Tran BC, Glick DR, Ha NT, ... Sachdeva A, Reed RM
J Heart Lung Transplant: 14 Mar 2023; epub ahead of print | PMID: 37140517
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<div><h4>A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom.</h4><i>Messer S, Rushton S, Simmonds L, Macklam D, ... Manas D, Berman M</i><br /><b>Background</b><br />The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported.<br /><b>Methods</b><br />This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon\'s rank-sum.<br /><b>Results</b><br />From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46).<br /><b>Conclusion</b><br />During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.<br /><br />Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 13 Mar 2023; epub ahead of print</small></div>
Messer S, Rushton S, Simmonds L, Macklam D, ... Manas D, Berman M
J Heart Lung Transplant: 13 Mar 2023; epub ahead of print | PMID: 37032222
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<div><h4>Left ventricular functional improvement appears to contribute to lower rates of device thrombosis in patients on durable mechanical circulatory support.</h4><i>Kyriakopoulos CP, Horne BD, Sideris K, Taleb I, ... Selzman CH, Drakos SG</i><br /><AbstractText>By unloading the failing heart, left ventricular (LV) assist devices (LVADs) provide a favorable environment for reversing adverse structural and functional cardiac changes. Prior reports have suggested that an improved native LV function might contribute to the development of LVAD thrombosis. We used the Interagency Registry for Mechanically Assisted Circulatory Support and found that LV functional improvement is associated with a lower risk for device thrombosis. The risk for cerebrovascular accident and transient ischemic attack was comparable across post-LVAD LV function subgroups, while the risk of hemolysis was lower in subgroups of patients with better LV function on LVAD support.</AbstractText><br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 13 Mar 2023; epub ahead of print</small></div>
Kyriakopoulos CP, Horne BD, Sideris K, Taleb I, ... Selzman CH, Drakos SG
J Heart Lung Transplant: 13 Mar 2023; epub ahead of print | PMID: 37086251
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<div><h4>Controlled donation after circulatory death lung transplantation: Results of the French protocol including in situ abdominal normothermic regional perfusion and ex vivo lung perfusion.</h4><i>De Wolf J, Fadel G, Olland A, Falcoz PE, ... Sage E, SFCTCV Lung Transplantation Group</i><br /><b>Background</b><br />The French national protocol for controlled donation after circulatory determination of death (cDCD) includes normothermic regional perfusion (NRP) in case of abdominal organ procurement and additional ex-vivo lung perfusion (EVLP) before considering lung transplantation (LT).<br /><b>Methods</b><br />We made a retrospective study of a prospective registry that included all donors considered for cDCD LT from the beginning of the program in May 2016 to November 2021.<br /><b>Results</b><br />One hundred grafts from 14 donor hospitals were accepted by 6 LT centers. The median duration of the agonal phase was 20 minutes [2-166]. The median duration from circulatory arrest to pulmonary flush was 62 minutes [20-90]. Ten lung grafts were not retrieved due to prolonged agonal phases (n = 3), failure of NRP insertion (n = 5), or poor in situ evaluation (n = 2). The remaining 90 lung grafts were all evaluated on EVLP, with a conversion rate of 84% and a cDCD transplantation rate of 76%. The median total preservation time was 707 minutes [543-1038]. Seventy-one bilateral LTs and 5 single LTs were performed for chronic obstructive pulmonary disease (n = 29), pulmonary fibrosis (n = 21), cystic fibrosis (n = 15), pulmonary hypertension (n = 8), graft-versus-host disease (n = 2), and adenosquamous carcinoma (n = 1). The rate of PGD3 was 9% (n = 5). The 1-year survival rate was 93.4%.<br /><b>Conclusion</b><br />After initial acceptance, cDCD lung grafts led to LT in 76% of cases, with outcomes similar to those already reported in the literature. The relative impacts of NRP and EVLP on the outcome following cDCD LT should be assessed prospectively in the context of comparative studies.<br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 13 Mar 2023; epub ahead of print</small></div>
De Wolf J, Fadel G, Olland A, Falcoz PE, ... Sage E, SFCTCV Lung Transplantation Group
J Heart Lung Transplant: 13 Mar 2023; epub ahead of print | PMID: 37019731
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<div><h4>Early United States experience with lung donation after circulatory death using thoracoabdominal normothermic regional perfusion.</h4><i>Zhou AL, Ruck JM, Casillan AJ, Larson EL, ... Merlo CA, Bush EL</i><br /><AbstractText>Thoracoabdominal normothermic regional perfusion (TA-NRP) has recently begun being utilized in the United States for recovery of cardiothoracic allografts from some donors after circulatory death (DCD), but data on lungs recovered in this method is limited to case reports. We conducted a national retrospective review of lung transplants from DCD donors recovered using TA-NRP. Of the 434 total DCD lung transplants performed between January 2020 and March 2022, 17 were recovered using TA-NRP. Compared to direct recovery DCD transplants, recipients of TA-NRP DCD transplants had lower likelihood of ventilation >48 hours (23.5% vs 51.3%, p = 0.027) and similar likelihood of predischarge acute rejection, requirement for extracorporeal membrane oxygenation at 72 hours, hospital lengths of stay, and survival at 30, 60, and 90 days post-transplant. These early data suggest that DCD lung recovery using TA-NRP might be a safe way to further expand the donor pool and warrant further study.</AbstractText><br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 08 Mar 2023; epub ahead of print</small></div>
Zhou AL, Ruck JM, Casillan AJ, Larson EL, ... Merlo CA, Bush EL
J Heart Lung Transplant: 08 Mar 2023; epub ahead of print | PMID: 36990867
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Abstract
<div><h4>Performance of risk stratification scores and role of comorbidities in older vs younger patients with pulmonary arterial hypertension.</h4><i>Stolfo D, Barbisan D, Ameri P, Lombardi CM, ... Sinagra G, Lo Giudice F</i><br /><b>Background</b><br />Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown.<br /><b>Methods</b><br />Patients with PAH enrolled from 2001 to 2021 were divided in ≥65 years old vs <65 years old patients. Study outcome was 5-year all-cause mortality. French Pulmonary Hypertension Network (FPHN), FPHN noninvasive, Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL 2.0) risk scores were calculated and patients categorized at low, intermediate and high risk. Number of comorbidities was calculated.<br /><b>Results</b><br />Among 383 patients, 152 (40%) were ≥65 years old. They had more comorbidities (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in <65 years patients). Five-year survival was 63% in ≥65 vs 90% in <65 years. Risk scores correctly discriminated the different classes of risk in the overall cohort and in the older and younger groups. REVEAL 2.0 showed the best accuracy in the total cohort (C-index 0.74, standard error-SE- 0.03) and older (C-index 0.69, SE 0.03) patients, whereas COMPERA 2.0 performed better in younger patients (C-index 0.75, SE 0.08). Number of comorbidities was associated with higher 5-year mortality, and consistently increased the accuracy of risk scores, in younger but not in older patients.<br /><b>Conclusions</b><br />Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients and COMPERA 2.0 had it in younger patients. Comorbidities increased the accuracy of risk scores only in younger patients.<br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 05 Mar 2023; epub ahead of print</small></div>
Stolfo D, Barbisan D, Ameri P, Lombardi CM, ... Sinagra G, Lo Giudice F
J Heart Lung Transplant: 05 Mar 2023; epub ahead of print | PMID: 37005100
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Abstract
<div><h4>Single-drug immunosuppression is associated with noninferior medium-term survival in pediatric heart transplant recipients.</h4><i>Watelle L, Touré M, Lamour JM, Kemna MS, ... Greenway SC, Dallaire F</i><br /><b>Background</b><br />Patients are usually maintained on at least 2 immunosuppressive drugs (ISDs) after the first year post heart transplant. Anecdotally, some children are switched to single-drug monotherapy (a single ISD) for various reasons and varying durations. Outcomes associated with differences in immunosuppression after heart transplantation are unknown for children.<br /><b>Objectives</b><br />A priori we defined a noninferiority hypothesis for monotherapy compared to ≥2 ISDs. The primary outcome was graft failure, a composite of death and retransplantation. Secondary outcomes included rejection, infection, malignancy, cardiac allograft vasculopathy and dialysis.<br /><b>Methods</b><br />This international, multicenter, retrospective, observational cohort study used data from the Pediatric Heart Transplant Society. We included patients who underwent first-time heart transplant <18 years of age between 1999 and 2020 with ≥1 year of follow-up data available.<br /><b>Results</b><br />Our analysis included 3493 patients with a median time post-transplant of 6.7 years. There were 893 patients (25.6%) switched to monotherapy at least once with the remaining 2600 patients always on ≥2 ISDs. The median time on monotherapy after the first year post-transplant was 2.8 years (range 1.1-5.9 years). We found an adjusted hazard ratio (HR) of 0.65 (95%CI: 0.47-0.88) favoring monotherapy compared to ≥2 ISDs (p = 0.002). There were no meaningful differences in the incidence of secondary outcomes between groups, except for a lower rate of cardiac allograft vasculopathy in patients on monotherapy (HR 0.58, 95%CI: 0.45-0.74).<br /><b>Conclusions</b><br />For pediatric heart transplant recipients placed on monotherapy, immunosuppression with a single ISD after the first year post-transplant was noninferior to standard therapy with ≥2 ISDs in the medium term.<br /><b>Condensed abstract</b><br />Some children are switched to a single immunosuppressive drug (ISD) for various reasons after heart transplant, but outcomes associated with differences in immunosuppression are unknown for children. We assessed graft failure in children on a single ISD (monotherapy) compared to ≥2 ISDs in a cohort of 3493 children with a first heart transplant. We found an adjusted hazard ratio of 0.65 (95%CI: 0.47-0.88) favoring monotherapy. We concluded that for pediatric heart transplant recipients placed on monotherapy, immunosuppression with a single ISD after the first year post-transplant was non-inferior to standard therapy with ≥2 ISDs in the medium term.<br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 04 Mar 2023; epub ahead of print</small></div>
Watelle L, Touré M, Lamour JM, Kemna MS, ... Greenway SC, Dallaire F
J Heart Lung Transplant: 04 Mar 2023; epub ahead of print | PMID: 36997361
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Abstract
<div><h4>Distal vessel pulmonary thromboendarterectomy: Results from a single institution.</h4><i>Fernandes TM, Kim NH, Kerr KM, Auger WR, ... Pretorius VG, Madani MM</i><br /><b>Background</b><br />Chronic thromboembolic pulmonary hypertension (CTEPH) is primarily managed by pulmonary thromboendarterectomy (PTE). As advanced surgical techniques permit resection at the segmental and subsegmental level, PTE can now be curative for CTEPH mostly involving the distal pulmonary arteries.<br /><b>Methods</b><br />Between January 2017 and June 2021, consecutive patients undergoing PTE were categorized according to the most proximal level of chronic thrombus resection: Level I (main pulmonary artery), Level II (lobar), Level III (segmental) and Level IV (subsegmental). Proximal disease patients (any Level I or II) were compared to distal disease (Level III or IV bilaterally) patients. Demographics, medical history, preoperative pulmonary hemodynamics, and immediate postoperative outcomes were obtained for each group.<br /><b>Results</b><br />During the study period, 794 patients underwent PTE, 563 with proximal disease and 231 with distal disease. Patients with distal disease more frequently had a history of an indwelling intravenous device, splenectomy, upper extremity thrombosis or use thyroid replacement and less often had prior lower extremity thrombosis or hypercoagulable state. Despite more use of PAH-targeted medications in the distal disease group (63.2% vs 50.1%, p < 0.001), preoperative hemodynamics were similar. Both patient groups exhibited significant improvements in pulmonary hemodynamics postoperatively with comparable in-hospital mortality rates. Compared to proximal disease, a lower percentage of patients with distal disease showed residual pulmonary hypertension (3.1% vs 6.9%, p = 0.039) and airway hemorrhage (3.0% vs 6.6%, p = 0.047) postoperatively.<br /><b>Conclusions</b><br />Thromboendarterectomy for distal (segmental and subsegmental) CTEPH is technically feasible and may result in favorable pulmonary hemodynamic outcomes, without increased mortality or morbidity.<br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 02 Mar 2023; epub ahead of print</small></div>
Fernandes TM, Kim NH, Kerr KM, Auger WR, ... Pretorius VG, Madani MM
J Heart Lung Transplant: 02 Mar 2023; epub ahead of print | PMID: 37024310
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Abstract
<div><h4>The intersection of race and ethnicity, gender, and primary diagnosis on lung transplantation outcomes.</h4><i>Bonner SN, Thumma JR, Valbuena VSM, Stewart JW, ... Lin J, Wakeam E</i><br /><b>Background</b><br />Reducing racial disparities in lung transplant outcomes is a current priority of providers, policymakers, and lung transplant centers. It is unknown how the combined effect of race and ethnicity, gender, and diagnosis group is associated with differences in 1-year mortality and 5-year survival.<br /><b>Methods</b><br />This is a longitudinal cohort study using Standard Transplant Analysis Research files from the United Network for organ sharing. A total of 25,444 patients undergoing first time lung transplantation between 2006 and 2019 in the United States. The primary exposures were lung transplant recipient race and ethnicity, gender, and primary diagnosis group at listing. Multivariable regression models and cox-proportional hazards models were used to determine adjusted 1-year mortality and 5-year survival.<br /><b>Results</b><br />Overall, 25,444 lung transplant patients were included in the cohort including 15,160 (59.6%) men, 21,345 (83.9%) White, 2,318 (9.1%), Black and Hispanic/Latino (7.0%). Overall, men had a significant higher 1-year mortality than women (11.87%; 95% CI 11.07-12.67 vs 12.82%; 95% CI 12.20%-13.44%). Black women had the highest mortality of all race and gender combinations (14.51%; 95% CI 12.15%-16.87%). Black patients with pulmonary vascular disease had the highest 1-year mortality (19.77%; 95% CI 12.46%-27.08%) while Hispanic/Latino patients with obstructive lung disease had the lowest (7.42%; 95% CI 2.8%-12.05%). 5-year adjusted survival was highest among Hispanic/Latino patients (62.32%) compared to Black (57.59%) and White patients (57.82%).<br /><b>Conclusions</b><br />There are significant differences in 1-year and 5-year mortality between and within racial and ethnic groups depending on gender and primary diagnosis. This demonstrates the impact of social and clinical factors on lung transplant outcomes.<br /><br />Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Heart Lung Transplant: 02 Mar 2023; epub ahead of print</small></div>
Bonner SN, Thumma JR, Valbuena VSM, Stewart JW, ... Lin J, Wakeam E
J Heart Lung Transplant: 02 Mar 2023; epub ahead of print | PMID: 36967318
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This program is still in alpha version.