Pub Date : 2026-05-01Epub Date: 2026-01-12DOI: 10.1016/j.jhlto.2026.100486
Salem T. Argaw , Ali Akamkam , Sébastien Hascoet , Stéphan Haulon , Julien Guihaire MD, PhD
Cardiac reoperation after an extra-anatomic aortic bypass graft entails considerable risk due to the proximity of the graft to the sternum. In the case discussed here, a woman with 2 prior sternotomies and a retrosternal aortic bypass graft for a history of aortic coarctation presented with advanced dilated cardiomyopathy requiring heart transplantation. The patient was managed through a novel 3-stage hybrid strategy. In the first stage, a catheter-based approach was used to stent the coarcted aorta. Subsequently, the extra-anatomic graft was endovascularly excluded and, finally, the patient underwent reoperation for heart transplantation. The use of interdisciplinary collaboration for coordinated staging and shared decision-making, as in this case, allows for innovative solutions and improved outcomes in complex surgical needs.
{"title":"A 3-stage hybrid strategy for heart transplantation following ascending-to-descending aortic bypass grafting","authors":"Salem T. Argaw , Ali Akamkam , Sébastien Hascoet , Stéphan Haulon , Julien Guihaire MD, PhD","doi":"10.1016/j.jhlto.2026.100486","DOIUrl":"10.1016/j.jhlto.2026.100486","url":null,"abstract":"<div><div>Cardiac reoperation after an extra-anatomic aortic bypass graft entails considerable risk due to the proximity of the graft to the sternum. In the case discussed here, a woman with 2 prior sternotomies and a retrosternal aortic bypass graft for a history of aortic coarctation presented with advanced dilated cardiomyopathy requiring heart transplantation. The patient was managed through a novel 3-stage hybrid strategy. In the first stage, a catheter-based approach was used to stent the coarcted aorta. Subsequently, the extra-anatomic graft was endovascularly excluded and, finally, the patient underwent reoperation for heart transplantation. The use of interdisciplinary collaboration for coordinated staging and shared decision-making, as in this case, allows for innovative solutions and improved outcomes in complex surgical needs.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100486"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146184044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-15DOI: 10.1016/j.jhlto.2026.100491
Doug A. Gouchoe MD , Ashley Cardenas MAS, FAST , Gary F. Marklin MD, MA , Errol Bush MD , Bryan A. Whitson MD, PhD , Jordan R.H. Hoffman MD, MPH , Darren Stewart MS , David A. Axelrod MD, MBA , Aleem Siddique MBBS, FACS, FACC
Lungs recovered from donation after circulatory death (DCD) are markedly underutilized for transplantation in the U.S. Evidence demonstrating excellent outcomes after DCD lung transplantation underpins the need for strategies to mitigate barriers to DCD lung utilization, including data driven revisions to allocation policy, revising program-specific quality metrics, removing financial barriers, and minimizing logistical disincentives. Expanded DCD transplantation is vital to reduce waitlist mortality and increase lung transplant rate.
{"title":"Promoting utilization of donors after circulatory death in lung transplantation","authors":"Doug A. Gouchoe MD , Ashley Cardenas MAS, FAST , Gary F. Marklin MD, MA , Errol Bush MD , Bryan A. Whitson MD, PhD , Jordan R.H. Hoffman MD, MPH , Darren Stewart MS , David A. Axelrod MD, MBA , Aleem Siddique MBBS, FACS, FACC","doi":"10.1016/j.jhlto.2026.100491","DOIUrl":"10.1016/j.jhlto.2026.100491","url":null,"abstract":"<div><div>Lungs recovered from donation after circulatory death (DCD) are markedly underutilized for transplantation in the U.S. Evidence demonstrating excellent outcomes after DCD lung transplantation underpins the need for strategies to mitigate barriers to DCD lung utilization, including data driven revisions to allocation policy, revising program-specific quality metrics, removing financial barriers, and minimizing logistical disincentives. Expanded DCD transplantation is vital to reduce waitlist mortality and increase lung transplant rate.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100491"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-13DOI: 10.1016/j.jhlto.2026.100482
Adam Lowe MD , S. Travis King PharmD , Jonathan Hand MD
Patients with mechanical circulatory support (MCS) devices and those who undergo heart transplants are at risk for invasive fungal infections (IFI). Though Candida and Aspergillus spp. account for most infections, the evolving epidemiology of resistant-Candida spp. such as Candida auris, endemic mycoses, and other molds impacted by climate change, threaten MCS and transplant patients. Fungal diagnostics are overall limited, and current, widely used antifungal agents are suboptimal with significant toxicities. However, innovative diagnostic strategies coupled with novel antifungal agents for prevention and treatment of invasive fungal disease encourage optimism for MCS and transplant patients and clinicians.
{"title":"The looming threat of invasive fungal infections in heart transplant recipients: Will it be the last of us","authors":"Adam Lowe MD , S. Travis King PharmD , Jonathan Hand MD","doi":"10.1016/j.jhlto.2026.100482","DOIUrl":"10.1016/j.jhlto.2026.100482","url":null,"abstract":"<div><div>Patients with mechanical circulatory support (MCS) devices and those who undergo heart transplants are at risk for invasive fungal infections (IFI). Though <em>Candida</em> and <em>Aspergillus spp.</em> account for most infections, the evolving epidemiology of resistant-<em>Candida spp</em>. such as <em>Candida auris</em>, endemic mycoses, and other molds impacted by climate change, threaten MCS and transplant patients. Fungal diagnostics are overall limited, and current, widely used antifungal agents are suboptimal with significant toxicities. However, innovative diagnostic strategies coupled with novel antifungal agents for prevention and treatment of invasive fungal disease encourage optimism for MCS and transplant patients and clinicians.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100482"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146057389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-20DOI: 10.1016/j.jhlto.2026.100496
Rossella Loria , Antonio Giuseppe Bianculli , Paola Giustiniani , Maria Troiano , Marco Andreani , Giorgia Grutter
Heart transplantation is the definitive treatment for patients with advanced heart failure and refractory symptoms. However, allograft rejection—both acute and chronic—remains a major cause of morbidity, leading to graft dysfunction and failure. Traditionally, endomyocardial biopsy (EMB) has been the standard method for screening allograft rejection. MicroRNAs (miRNAs) are small, non-coding RNA sequences that regulate gene expression by binding to the 3' untranslated regions of complementary mRNA transcripts. This review explores the potential of miRNAs as biomarkers for detecting allograft rejection in heart transplant recipients. MiRNAs may serve as non-invasive “liquid biopsies,” providing a novel approach to monitor and manage post-transplant patients.
{"title":"MicroRNAs and their role in heart transplantation insights into rejection mechanisms: A narrative review","authors":"Rossella Loria , Antonio Giuseppe Bianculli , Paola Giustiniani , Maria Troiano , Marco Andreani , Giorgia Grutter","doi":"10.1016/j.jhlto.2026.100496","DOIUrl":"10.1016/j.jhlto.2026.100496","url":null,"abstract":"<div><div>Heart transplantation is the definitive treatment for patients with advanced heart failure and refractory symptoms. However, allograft rejection—both acute and chronic—remains a major cause of morbidity, leading to graft dysfunction and failure. Traditionally, endomyocardial biopsy (EMB) has been the standard method for screening allograft rejection. MicroRNAs (miRNAs) are small, non-coding RNA sequences that regulate gene expression by binding to the 3' untranslated regions of complementary mRNA transcripts. This review explores the potential of miRNAs as biomarkers for detecting allograft rejection in heart transplant recipients. MiRNAs may serve as non-invasive “liquid biopsies,” providing a novel approach to monitor and manage post-transplant patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100496"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-17DOI: 10.1016/j.jhlto.2026.100492
Antoine Premachandra MD , Jacob Klapper MD , Jonathan Messika MD, PhD , Maira Gaillard MD , Martin Kloeckner MD , Kamrouz Ghadimi MD, MHSc , Matthieu Reffienna PT , Krista Ingle PhD , Kirti Magudia MD , Brandi Bottiger MD
Frailty is an important syndrome in an aging thoracic transplant population, particularly in the context of end-stage cardiopulmonary disease. In this review, we discuss the core problem of lack of physiologic reserve in these patients and its relationship to perioperative outcomes, how to define and measure frailty in the context of heart and lung transplant and identify interventions to treat contributors to this clinical syndrome. We highlight the critical need in the transplant community to identify and treat these conditions prior to their transplantation and to prevent comorbidity and mortality.
{"title":"Frailty assessment and candidate optimization before cardiothoracic transplantation","authors":"Antoine Premachandra MD , Jacob Klapper MD , Jonathan Messika MD, PhD , Maira Gaillard MD , Martin Kloeckner MD , Kamrouz Ghadimi MD, MHSc , Matthieu Reffienna PT , Krista Ingle PhD , Kirti Magudia MD , Brandi Bottiger MD","doi":"10.1016/j.jhlto.2026.100492","DOIUrl":"10.1016/j.jhlto.2026.100492","url":null,"abstract":"<div><div>Frailty is an important syndrome in an aging thoracic transplant population, particularly in the context of end-stage cardiopulmonary disease. In this review, we discuss the core problem of lack of physiologic reserve in these patients and its relationship to perioperative outcomes, how to define and measure frailty in the context of heart and lung transplant and identify interventions to treat contributors to this clinical syndrome. We highlight the critical need in the transplant community to identify and treat these conditions prior to their transplantation and to prevent comorbidity and mortality.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100492"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-04-23DOI: 10.1016/j.jhlto.2026.100553
Keerthana Sankar MD , Laura DiChiacchio MD, PhD , Yuri Matusov MD , Pedro Catarino MD , Dominick Megna MD , Lorenzo Zaffiri MD, PhD , Jeremy Falk MD , Peter Chen MD , Reinaldo Rampolla MD
Background
Baseline lung allograft dysfunction (BLAD) is a phenotype of early graft dysfunction associated with impaired survival after lung transplantation. Although prior work links BLAD with several pre- and post-transplant factors, a robust set of donor and recipient predictors remains unclear.
Research Question
What are important donor and recipient predictors of BLAD?
Methods
We retrospectively reviewed 124 adults who underwent bilateral lung transplantation at a single center. Donor and recipient variables were evaluated using machine learning (gradient boosting and classification tree models), with high-importance predictors incorporated into logistic regression. Survival was assessed using Kaplan-Meier and Cox proportional hazards models.
Results
BLAD occurred in 58 of 124 patients (46.7%). Our analysis identified 7 key factors associated with BLAD: Increased cold ischemia time (p = 0.04) and extremes of Body Mass Index (BMI) (p = 0.04) were associated with BLAD in a non-linear manner. Increased post-transplant Intensive Care Unit (ICU) length of stay (Odds Ratio [OR]: 1.08, 95% Confidence Interval [CI]: 1.00-1.17, p = 0.04) and donor tobacco use > 20 pack years (OR: 16.83, 95% CI: 2.34-121.2, p = 0.005) were also associated with higher odds of BLAD. Female sex (OR: 0.08, 95% CI: 0.02-0.39, p = 0.002), older age (OR: 0.93, 95% CI: 0.88-0.97, p = 0.003), and higher pre-operative Forced Expiratory Volume in 1 second (FEV₁) (OR: 0.19, 95% CI: 0.07-0.55, p = 0.002) were associated with lower odds of BLAD. The model demonstrated strong predictive performance (C-index 0.79, cross-validated). Patients with moderate to severe BLAD (Grade 2 and 3) had a significantly increased risk of death over a median follow-up period of 815 days (Hazard Ratio [HR] 3.53, 95% CI: 1.07-11.71, p = 0.04).
Conclusions
BLAD is common after bilateral lung transplantation. Moderate to severe BLAD is associated with worse survival. Machine learning identified biological variables associated with BLAD and modifiable peri-operative variables, highlighting opportunities for pre-transplant and intra-operative optimization.
基线肺同种异体移植物功能障碍（BLAD）是一种与肺移植后生存受损相关的早期移植物功能障碍表型。尽管先前的研究将BLAD与移植前和移植后的几个因素联系起来，但一套可靠的供体和受体预测因素仍不清楚。研究问题：BLAD的重要供体和受体预测因子是什么？方法回顾性分析124例在同一中心接受双侧肺移植的成人患者。使用机器学习（梯度增强和分类树模型）评估供体和受体变量，并将高度重要的预测因子纳入逻辑回归。生存率采用Kaplan-Meier和Cox比例风险模型进行评估。结果124例患者中有58例（46.7%）发生blad。我们的分析确定了与BLAD相关的7个关键因素：增加冷缺血时间（p = 0.04）和身体质量指数（BMI）极值（p = 0.04）以非线性方式与BLAD相关。移植后重症监护病房（ICU）住院时间的增加（优势比[OR]: 1.08, 95%可信区间[CI]: 1.00-1.17, p = 0.04）和供体吸烟20包年（OR: 16.83, 95% CI: 2.34-121.2, p = 0.005）也与BLAD的高发生率相关。女性（OR: 0.08, 95% CI: 0.02-0.39, p = 0.002）、年龄较大（OR: 0.93, 95% CI: 0.88-0.97, p = 0.003）和术前1秒用力呼气量（OR: 0.19, 95% CI: 0.07-0.55, p = 0.002）与较低的BLAD发生率相关。该模型具有较强的预测性能（c指数0.79，交叉验证）。中度至重度BLAD（2级和3级）患者在815天的中位随访期间死亡风险显著增加（风险比[HR] 3.53, 95% CI: 1.07-11.71, p = 0.04）。结论双侧肺移植术后blad较为常见。中度至重度BLAD与较差的生存率相关。机器学习识别了与BLAD相关的生物变量和可修改的围手术期变量，突出了移植前和术中优化的机会。
{"title":"Machine learning analysis identifies key predictors of baseline lung allograft dysfunction and increased mortality in lung transplant patients","authors":"Keerthana Sankar MD , Laura DiChiacchio MD, PhD , Yuri Matusov MD , Pedro Catarino MD , Dominick Megna MD , Lorenzo Zaffiri MD, PhD , Jeremy Falk MD , Peter Chen MD , Reinaldo Rampolla MD","doi":"10.1016/j.jhlto.2026.100553","DOIUrl":"10.1016/j.jhlto.2026.100553","url":null,"abstract":"<div><h3>Background</h3><div>Baseline lung allograft dysfunction (BLAD) is a phenotype of early graft dysfunction associated with impaired survival after lung transplantation. Although prior work links BLAD with several pre- and post-transplant factors, a robust set of donor and recipient predictors remains unclear.</div></div><div><h3>Research Question</h3><div>What are important donor and recipient predictors of BLAD?</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 124 adults who underwent bilateral lung transplantation at a single center. Donor and recipient variables were evaluated using machine learning (gradient boosting and classification tree models), with high-importance predictors incorporated into logistic regression. Survival was assessed using Kaplan-Meier and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>BLAD occurred in 58 of 124 patients (46.7%). Our analysis identified 7 key factors associated with BLAD: Increased cold ischemia time (<em>p</em> = 0.04) and extremes of Body Mass Index (BMI) (p = 0.04) were associated with BLAD in a non-linear manner. Increased post-transplant Intensive Care Unit (ICU) length of stay (Odds Ratio [OR]: 1.08, 95% Confidence Interval [CI]: 1.00-1.17, <em>p</em> = 0.04) and donor tobacco use > 20 pack years (OR: 16.83, 95% CI: 2.34-121.2, <em>p</em> = 0.005) were also associated with higher odds of BLAD. Female sex (OR: 0.08, 95% CI: 0.02-0.39, <em>p</em> = 0.002), older age (OR: 0.93, 95% CI: 0.88-0.97, <em>p</em> = 0.003), and higher pre-operative Forced Expiratory Volume in 1 second (FEV₁) (OR: 0.19, 95% CI: 0.07-0.55, <em>p</em> = 0.002) were associated with lower odds of BLAD. The model demonstrated strong predictive performance (C-index 0.79, cross-validated). Patients with moderate to severe BLAD (Grade 2 and 3) had a significantly increased risk of death over a median follow-up period of 815 days (Hazard Ratio [HR] 3.53, 95% CI: 1.07-11.71, <em>p</em> = 0.04).</div></div><div><h3>Conclusions</h3><div>BLAD is common after bilateral lung transplantation. Moderate to severe BLAD is associated with worse survival. Machine learning identified biological variables associated with BLAD and modifiable peri-operative variables, highlighting opportunities for pre-transplant and intra-operative optimization.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100553"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147995443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-23DOI: 10.1016/j.jhlto.2026.100497
Anh Nguyen MD, PhD , Abbas Rana MD , Alexis Shafii MD , Gabriel Loor MD , Andrew Civitello MD , Todd Rosengart MD , Kenneth Liao MD, PhD
Background
Current International Society for Heart and Lung Transplantation guidelines support the use of donor hearts aged ≥45 if significant coronary artery disease is excluded and ischemic time remains <4 hours. This study aimed to identify additional risk factors affecting patient survival and develop a risk score for recipients of older donor hearts.
Methods
We performed a retrospective cohort study of adult heart transplants using donors aged ≥45 from January 2000 to June 2024, using United Network for Organ Sharing data. Multivariable Cox regression identified risk factors for mortality, and the most significant variables were used to construct a risk score.
Results
Of 58,859 adult heart transplants, 9,843 (16.7%) involved donors aged ≥45. Recipient median age was 58 years (interquartile range, 51-64). One-, 5-, and 10-year patient survival rates were 87.0%, 73.3%, and 53.5%, respectively. Statistically significant risk factors included ischemic time ≥4 hours (HR = 1.11), cytomegalovirus (CMV)-positive donor status (hazard ratio [HR] = 1.11), donor cigarette use (HR = 1.10) and recipient factors: age >55 (HR = 1.37), Black race (HR = 1.19), obesity (HR = 1.20), diabetes (HR = 1.27), pretransplant dialysis (HR = 1.44), pretransplant mechanical ventilator use (HR = 1.37), and prior cardiac surgery (HR = 1.28). Model discrimination was moderate with C-statistics of 0.58.
Conclusions
When considering heart transplants with donors aged ≥45, we should screen for ischemic time ≥4 hours, CMV-positive donor, donor cigarette use, and the following recipient factors: age >55, Black race, obesity, diabetes, pretransplant dialysis or mechanical ventilation, and prior cardiac surgery.
{"title":"Risk factors when considering heart transplants with donors aged 45 or above: Development of a Novel Mortality Risk Score using UNOS data","authors":"Anh Nguyen MD, PhD , Abbas Rana MD , Alexis Shafii MD , Gabriel Loor MD , Andrew Civitello MD , Todd Rosengart MD , Kenneth Liao MD, PhD","doi":"10.1016/j.jhlto.2026.100497","DOIUrl":"10.1016/j.jhlto.2026.100497","url":null,"abstract":"<div><h3>Background</h3><div>Current International Society for Heart and Lung Transplantation guidelines support the use of donor hearts aged ≥45 if significant coronary artery disease is excluded and ischemic time remains <4 hours. This study aimed to identify additional risk factors affecting patient survival and develop a risk score for recipients of older donor hearts.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of adult heart transplants using donors aged ≥45 from January 2000 to June 2024, using United Network for Organ Sharing data. Multivariable Cox regression identified risk factors for mortality, and the most significant variables were used to construct a risk score.</div></div><div><h3>Results</h3><div>Of 58,859 adult heart transplants, 9,843 (16.7%) involved donors aged ≥45. Recipient median age was 58 years (interquartile range, 51-64). One-, 5-, and 10-year patient survival rates were 87.0%, 73.3%, and 53.5%, respectively. Statistically significant risk factors included ischemic time ≥4 hours (HR = 1.11), cytomegalovirus (CMV)-positive donor status (hazard ratio [HR] = 1.11), donor cigarette use (HR = 1.10) and recipient factors: age >55 (HR = 1.37), Black race (HR = 1.19), obesity (HR = 1.20), diabetes (HR = 1.27), pretransplant dialysis (HR = 1.44), pretransplant mechanical ventilator use (HR = 1.37), and prior cardiac surgery (HR = 1.28). Model discrimination was moderate with C-statistics of 0.58.</div></div><div><h3>Conclusions</h3><div>When considering heart transplants with donors aged ≥45, we should screen for ischemic time ≥4 hours, CMV-positive donor, donor cigarette use, and the following recipient factors: age >55, Black race, obesity, diabetes, pretransplant dialysis or mechanical ventilation, and prior cardiac surgery.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-16DOI: 10.1016/j.jhlto.2025.100449
Brennan J. Collis BBIOMED, MD, Madeleine R. Heldman MD, MS , Cameron R. Wolfe MBBS(Hons), MPH
Background
Cytomegalovirus (CMV) is a major cause of morbidity following solid organ transplantation, with thoracic organ transplant recipients (TOTRs) representing one of the highest risk groups. Despite this elevated risk, TOTRs are under-represented in clinical research, and current management strategies are largely extrapolated from other transplant populations.
Methods
This review synthesizes evidence on CMV epidemiology, clinical outcomes, prevention, and treatment in TOTRs.
Key content
Despite the success of antiviral prophylaxis and pre-emptive monitoring strategies in reducing CMV-related complications in this population, late-onset infection and antiviral resistance remain major clinical challenges. We explore the potential role of CMV in chronic rejection, evaluate the utility of CMV cell-mediated immune monitoring, and review the clinical experience with novel antivirals in TOTRs. By identifying key evidence gaps and outlining priorities for future research, this review aims to support the development of targeted and more effective CMV management strategies in this high-risk population.
{"title":"Cytomegalovirus infections in thoracic organ transplant recipients: Updates on prevention, treatment, and immune monitoring","authors":"Brennan J. Collis BBIOMED, MD, Madeleine R. Heldman MD, MS , Cameron R. Wolfe MBBS(Hons), MPH","doi":"10.1016/j.jhlto.2025.100449","DOIUrl":"10.1016/j.jhlto.2025.100449","url":null,"abstract":"<div><h3>Background</h3><div>Cytomegalovirus (CMV) is a major cause of morbidity following solid organ transplantation, with thoracic organ transplant recipients (TOTRs) representing one of the highest risk groups. Despite this elevated risk, TOTRs are under-represented in clinical research, and current management strategies are largely extrapolated from other transplant populations.</div></div><div><h3>Methods</h3><div>This review synthesizes evidence on CMV epidemiology, clinical outcomes, prevention, and treatment in TOTRs.</div></div><div><h3>Key content</h3><div>Despite the success of antiviral prophylaxis and pre-emptive monitoring strategies in reducing CMV-related complications in this population, late-onset infection and antiviral resistance remain major clinical challenges. We explore the potential role of CMV in chronic rejection, evaluate the utility of CMV cell-mediated immune monitoring, and review the clinical experience with novel antivirals in TOTRs. By identifying key evidence gaps and outlining priorities for future research, this review aims to support the development of targeted and more effective CMV management strategies in this high-risk population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100449"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2025-11-27DOI: 10.1016/j.jhlto.2025.100452
Myrthe B. Bolt , Johanna P. van Gemert , Coretta van Leer-Buter , Erik A.M. Verschuuren , On behalf of TransplantLines, UMCG
Asymptomatic community-acquired respiratory viral (CARV) carriage before lung transplantation (LTx) has not been studied. This study analyzed CARV carriage pre-LTx and its impact on early post-LTx outcome. This retrospective cohort study included adult LTx recipients at UMC Groningen from January 2017 to August 2023. Pre-LTx viral swabs were routinely tested for CARV. The primary outcome was incidence of primary graft dysfunction (PGD) at 48 or 72 h post-LTx. Secondary outcomes included mechanical ventilation duration, ICU stay, hospital length of stay (LOS), 30- and 90-day mortality, and early rejection therapy. Of 222 recipients, 23 (10.4%) tested positive for a CARV, most commonly rhinovirus (n=10). PGD grade 3 occurred in 14.3% of CARV-positive vs. 9.1% of CARV-negative recipients (p=0.434). No differences were observed in secondary outcomes. Our study provides early data suggesting that asymptomatic carriage may not be associated with worse short-term outcomes.
{"title":"SCARCE: aSymptomatic respiratory viral Carriage in pre-lung transplant recipients and the effect on eArly-post lung tRansplant CoursE","authors":"Myrthe B. Bolt , Johanna P. van Gemert , Coretta van Leer-Buter , Erik A.M. Verschuuren , On behalf of TransplantLines, UMCG","doi":"10.1016/j.jhlto.2025.100452","DOIUrl":"10.1016/j.jhlto.2025.100452","url":null,"abstract":"<div><div>Asymptomatic community-acquired respiratory viral (CARV) carriage before lung transplantation (LTx) has not been studied. This study analyzed CARV carriage pre-LTx and its impact on early post-LTx outcome. This retrospective cohort study included adult LTx recipients at UMC Groningen from January 2017 to August 2023. Pre-LTx viral swabs were routinely tested for CARV. The primary outcome was incidence of primary graft dysfunction (PGD) at 48 or 72 h post-LTx. Secondary outcomes included mechanical ventilation duration, ICU stay, hospital length of stay (LOS), 30- and 90-day mortality, and early rejection therapy. Of 222 recipients, 23 (10.4%) tested positive for a CARV, most commonly rhinovirus (n=10). PGD grade 3 occurred in 14.3% of CARV-positive vs. 9.1% of CARV-negative recipients (p=0.434). No differences were observed in secondary outcomes. Our study provides early data suggesting that asymptomatic carriage may not be associated with worse short-term outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100452"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146184038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-16DOI: 10.1016/j.jhlto.2026.100490
Justin Issard , Claire Merveilleux du Vignaux , Sébastien Renard , Thierry Lepoivre , Paul Michel Mertes , Richard Dorent , Eric Epailly , Sébastien Hascoet , Anne Olland , Jérôme Le Pavec , Elie Fadel , Laurent Savale , Olaf Mercier MD, PhD
Background
Our study aims to describe the French heart–lung graft allocation system, to compare it with allocation systems used in other countries, and to explore potential solutions to improve access to this rare transplantation procedure.
Methods
Our study integrates published literature and multidisciplinary expert opinions to examine heart–lung graft allocation in France.
Results
The heart–lung transplantation (HLTx) programme was initiated in France in 1987. The number of procedures then increased steadily until the 2010s. Improved knowledge on right ventricular function recovery after double lung transplantation (LTx) for pulmonary hypertension combined with the organ shortage then led to a sharp drop in the number of HLTx recipients worldwide. In France, the number of HLTx procedures is only about ten per year and the main indication is Eisenmenger syndrome. Most HLTx candidates in France receive grafts only if they are in the high-urgency category highlighting the difficulty of access to heart–lung transplants. A re-appraisal of graft allocation rules thus seems mandatory to allow graft access to patients who do not meet high-urgency criteria and whose better general health predicts better post-HLTx outcomes.
Conclusions
As HLTx candidates in France are placed on the heart-transplant list in competition with heart-only transplant candidate, one option would be to reconsider the heart score assigned to HLTx candidates upon listing.
{"title":"Heart–Lung transplantation: Meeting allocation challenges in France","authors":"Justin Issard , Claire Merveilleux du Vignaux , Sébastien Renard , Thierry Lepoivre , Paul Michel Mertes , Richard Dorent , Eric Epailly , Sébastien Hascoet , Anne Olland , Jérôme Le Pavec , Elie Fadel , Laurent Savale , Olaf Mercier MD, PhD","doi":"10.1016/j.jhlto.2026.100490","DOIUrl":"10.1016/j.jhlto.2026.100490","url":null,"abstract":"<div><h3>Background</h3><div>Our study aims to describe the French heart–lung graft allocation system, to compare it with allocation systems used in other countries, and to explore potential solutions to improve access to this rare transplantation procedure.</div></div><div><h3>Methods</h3><div>Our study integrates published literature and multidisciplinary expert opinions to examine heart–lung graft allocation in France.</div></div><div><h3>Results</h3><div>The heart–lung transplantation (HLTx) programme was initiated in France in 1987. The number of procedures then increased steadily until the 2010s. Improved knowledge on right ventricular function recovery after double lung transplantation (LTx) for pulmonary hypertension combined with the organ shortage then led to a sharp drop in the number of HLTx recipients worldwide. In France, the number of HLTx procedures is only about ten per year and the main indication is Eisenmenger syndrome. Most HLTx candidates in France receive grafts only if they are in the high-urgency category highlighting the difficulty of access to heart–lung transplants. A re-appraisal of graft allocation rules thus seems mandatory to allow graft access to patients who do not meet high-urgency criteria and whose better general health predicts better post-HLTx outcomes.</div></div><div><h3>Conclusions</h3><div>As HLTx candidates in France are placed on the heart-transplant list in competition with heart-only transplant candidate, one option would be to reconsider the heart score assigned to HLTx candidates upon listing.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100490"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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