JHLT Open最新文献_第4页

Safety and efficacy of sodium-glucose cotransporter 2 inhibitors in post-heart transplant patients: A multi-center retrospective cohort study 钠-葡萄糖共转运蛋白2抑制剂在心脏移植后患者中的安全性和有效性：一项多中心回顾性队列研究

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-12-24 DOI: 10.1016/j.jhlto.2025.100465

Josephine Harrington , Alex Severino , Lisa Yanek , Nadia Fida , Farhan Ishaq , Farrah Al-Saffar , Evelyn Song , Katherine Clark , Teresa De Marco , H. Luise Holzhauser , Amanda Vest , Priya Umapathi

Background

Despite compelling mechanistic and clinical data supporting the use of sodium glucose cotransporter 2 inhibitors (SGLT2i) in heart failure, chronic kidney disease (CKD), and type 2 diabetes (T2DM), the safety and efficacy of SGLT2i in patients with prior orthotopic heart transplant (OHT) patients remain underexplored, potentially due to concerns surrounding infection risk and kidney injury.

Methods

This was a retrospective cohort study of patients receiving an SGLT2i following OHT at 7 large transplant centers between July 2016 and December 2023 to assess safety and tolerability. Key outcomes of interest included hospitalization attributed to SGLT2i use, genital/urinary tract (GU) infection, and acute kidney injury (AKI), as well as discontinuation of SGLT2i.

Results

Overall, 141 patients across 7 transplant centers were included in this cohort analysis. Patients had a median age of 61, and the median time from transplant was 5.3 years. Rates of hospitalization related to SGLT2i were low, occurring in 1.4% of the study population (2/141) at a rate of 0.007 events/person-year. GU infections occurred in 9.93% (14/141) of patients, and AKI within 30 days was observed in 20.59% (21/102 patients who had a complete dataset available for analysis). At the end of the observation period, 68.1% of patients remained on an SGLT2i, and 31.9% had discontinued their SGLT2i: 15.6% of patients discontinued their SGLT2i for medical reasons, most commonly AKI or GU infection.

Conclusion

Our results suggest that though discontinuation of SGLT2i use was high in patients post-OHT, the overall safety profile of the drug class was reassuring, with a low observed risk of hospitalization, kidney failure, or GU infection. Future larger prospective studies are needed to more fully elucidate the impact of SGLT2i on long-term outcomes in patients following OHT.

背景：尽管有令人信服的机制和临床数据支持葡萄糖共转运蛋白2抑制剂钠（SGLT2i）在心力衰竭、慢性肾病（CKD）和2型糖尿病（T2DM）中的应用，但SGLT2i在既往原位心脏移植（OHT）患者中的安全性和有效性仍未得到充分研究，可能是由于对感染风险和肾损伤的担忧。方法：本研究是一项回顾性队列研究，研究对象为2016年7月至2023年12月在7个大型移植中心接受OHT后SGLT2i的患者，以评估安全性和耐受性。主要结局包括因使用SGLT2i而住院、生殖器/尿路（GU）感染、急性肾损伤（AKI）以及停止使用SGLT2i。结果共纳入7个移植中心的141例患者。患者的中位年龄为61岁，中位移植时间为5.3年。与SGLT2i相关的住院率很低，发生在1.4%的研究人群中（2/141），发生率为0.007事件/人年。9.93%（14/141）的患者发生GU感染，20.59%（21/102）的患者在30天内出现AKI（有完整数据可分析）。在观察结束时，68.1%的患者仍在使用SGLT2i， 31.9%的患者停止使用SGLT2i， 15.6%的患者因医学原因停止使用SGLT2i，最常见的是AKI或GU感染。结论：我们的研究结果表明，尽管oht后患者停用SGLT2i的比例很高，但该药物类别的总体安全性令人放心，住院、肾衰竭或GU感染的观察风险较低。未来需要更大规模的前瞻性研究来更充分地阐明SGLT2i对OHT患者长期预后的影响。

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引用次数: 0

Donation after circulatory death in adult congenital heart disease: A fragile match 成人先天性心脏病循环死亡后的捐赠：一个脆弱的匹配。

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-11-12 DOI: 10.1016/j.jhlto.2025.100414

Jose B. Cruz Rodriguez , Deepak Acharya

引用次数: 0

Reflecting on the potential impact of donor-derived Kaposi sarcoma in lung transplantation 反思供体源性卡波西肉瘤在肺移植中的潜在影响

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-12-30 DOI: 10.1016/j.jhlto.2025.100471

Zsofia Rosselli

引用次数: 0

Contemporary evidence to inform management of deceased potential thoracic organ donors after brain death 当代证据为脑死亡后已死亡的潜在胸腔器官供体的管理提供信息

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-12-29 DOI: 10.1016/j.jhlto.2025.100474

Federico Ciardi MBBS , Chiara Magri MD , Antonio Rubino MD , Emily A. Vail MD, MSc

Brain death triggers profound physiologic derangements that threaten organ viability and contribute to the persistent shortage of transplantable thoracic organs. This narrative review synthesizes contemporary evidence informing the management of deceased potential thoracic organ donors after brain death, focusing on clinical studies published over the past decade. We identified 14 trials addressing key aspects of donor management, including lung-protective ventilation strategies, prone positioning, targeted temperature management, hormonal supplementation, and cardiovascular support. Notable findings include validation of lung-protective ventilation with higher positive end-expiratory pressure improving lung recovery rates, observational evidence suggesting that prone position is associated with increased lung and heart procurement, and recent randomized trials demonstrating no benefit from routine levothyroxine administration even in hemodynamically unstable donors. Corticosteroid therapy appears to effectively reduce vasopressor requirements, while newer evidence supports the safety of lower-dose regimens with improved glycemic control. Despite these advances, significant knowledge gaps persist regarding optimal hemodynamic monitoring, vasopressor selection, and other fundamental management decisions. The fragmented nature of the donation and transplantation system presents unique challenges for evidence generation and implementation. Ongoing developments, including donor care units, international collaboration, and innovative trial designs, offer opportunities to address these gaps. This review provides intensivists with an evidence-based framework for optimizing donor management while highlighting priority areas for future research to increase the availability and quality of thoracic organs for transplantation.

脑死亡会引发严重的生理紊乱，威胁器官的生存能力，并导致可移植胸腔器官的持续短缺。这篇叙述性综述综合了当代证据，为脑死亡后死亡的潜在胸腔器官供体的管理提供了信息，重点是过去十年发表的临床研究。我们确定了14项涉及供体管理关键方面的试验，包括肺保护性通气策略、俯卧位、目标温度管理、激素补充和心血管支持。值得注意的发现包括验证了高呼气末正压肺保护性通气可提高肺恢复率，观察性证据表明俯卧位与肺和心脏获取增加相关，以及最近的随机试验表明常规左旋甲状腺素治疗即使在血流动力学不稳定的供体中也没有益处。皮质类固醇治疗似乎有效地降低了血管加压素的需求，而新的证据支持低剂量方案的安全性，改善血糖控制。尽管取得了这些进展，但在最佳血流动力学监测、血管加压剂选择和其他基本管理决策方面，仍存在显著的知识差距。捐赠和移植系统的碎片化性质对证据的产生和实施提出了独特的挑战。目前的发展，包括供体护理单位、国际合作和创新试验设计，为解决这些差距提供了机会。这篇综述为强化医生提供了一个优化供体管理的循证框架，同时强调了未来研究的重点领域，以提高胸器官移植的可用性和质量。

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引用次数: 0

Prognostic impact of the geriatric nutritional risk index on waitlist mortality in adult patients listed for lung transplantation from donation after brain death 老年营养风险指数对脑死亡后捐献肺移植成人患者等待名单死亡率的影响

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-12-05 DOI: 10.1016/j.jhlto.2025.100424

Gouji Toyokawa MD, PhD , Miho Yamaguchi MD, PhD , Takafumi Yamaya MD , Takaki Aakamine MD, PhD , Mitsuaki Kawashima MD, PhD , Chihiro Konoeda MD, PhD , Mototsugu Shimokawa PhD , Masaaki Sato MD, PhD

Background

The geriatric nutritional risk index (GNRI) was developed to assess nutritional status of elderly patients, and is a recognized prognostic factor in various diseases. However, its role in patients awaiting lung transplantation (LT) from donation after brain death (DBD) remains unclear.

Methods

We retrospectively analyzed adult patients registered for LT from DBD between January 2014 and July 2023. GNRI was calculated using the formula: (1.489 x serum albumin [g/dL]) + (41.7 x [current body weight / ideal body weight]). Its cut-off value was determined by receiver operating characteristic curve analysis for waitlist mortality. The primary objective was to clarify the association between GNRI and waitlist mortality.

Results

The study included 354 patients; 147 (41.5%) survived to receive LT, while 105 (29.7%) died on the waiting list. The GNRI cut-off value was 93.84, with an area under the curve of 0.623. The low GNRI group (n = 122 [34.5%]) had significantly lower body mass index (P < 0.001), shorter 6-minute walk distance (P = 0.002), and higher need for oxygen supplementation (P = 0.015) compared to the high GNRI group (n = 232 [65.5%]). Multivariate analysis identified GNRI (P = 0.024), age (P = 0.047), sex (P = 0.013), 6-minute walk distance (P < 0.001), forced vital capacity (P = 0.023), and disease category (P = 0.036), as significant independent prognostic factors for survival.

Conclusions

GNRI is a significant prognostic indicator for survival in patients awaiting LT from DBD, and may aid in pre-transplant evaluation.

老年营养风险指数（GNRI）是一种评估老年患者营养状况的指标，是多种疾病的公认预后因素。然而，它在脑死亡（DBD）后等待捐赠肺移植（LT）的患者中的作用尚不清楚。方法回顾性分析2014年1月至2023年7月登记的成年DBD患者。GNRI的计算公式为：（1.489 x血清白蛋白[g/dL]） + （41.7 x[当前体重/理想体重]）。它的临界值是由等待名单死亡率的接受者工作特征曲线分析确定的。主要目的是澄清GNRI与等候名单死亡率之间的关系。结果共纳入354例患者；147例（41.5%）存活，105例（29.7%）在等待名单中死亡。GNRI截断值为93.84，曲线下面积为0.623。与高GNRI组（n = 232[65.5%]）相比，低GNRI组（n = 122[34.5%]）的体重指数显著降低（P < 0.001）， 6分钟步行距离较短（P = 0.002），补氧需求较高（P = 0.015）。多因素分析发现，GNRI （P = 0.024）、年龄（P = 0.047）、性别（P = 0.013）、6分钟步行距离（P < 0.001）、强迫肺活量（P = 0.023）和疾病类别（P = 0.036）是影响生存的重要独立预后因素。结论gnri是衡量DBD患者等待肝移植患者生存的重要预后指标，可能有助于移植前评估。

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引用次数: 0

Mechano-energetic uncoupling in the right ventricle in pulmonary hypertension 肺动脉高压患者右心室机械-能量解耦

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-12-06 DOI: 10.1016/j.jhlto.2025.100460

Peng Zhang MD , Reza Avazmohammadi PhD , Kurt W. Prins MD, PhD , Gaurav Choudhary MD

Pulmonary Hypertension (PH) affects up to 1% of the world population and is commonly associated with cardiopulmonary diseases. Right ventricular (RV) dysfunction and failure in response to the persistently increased RV afterload are the main cause of the morbidity and mortality in PH. As PH progresses, there is uncoupling of the RV-pulmonary artery (PA), resulting in RV failure. Strategies to optimize RV-PA coupling so far have mainly focused on lowering RV afterload with fewer options available to increase RV contractility. Here, we provide a perspective that there exists another type of “uncoupling”, between energy production and mechanical work within the RV, that reflects the competition between contractility (demand) and metabolism (supply). This uncoupling is a result of increased myocardial stiffness in the RV in PH, along with decreased energy production. We propose that optimizing mechano-energetic uncoupling by decreasing stiffness and increasing energetic capacity would be important as we seek to target the failing RV to improve RV-PA coupling and ultimately outcomes in patients with PH.

肺动脉高压（PH）影响世界人口的1%，通常与心肺疾病有关。右心室（RV）功能障碍和衰竭对持续增加的右心室后负荷的反应是PH发病率和死亡率的主要原因。随着PH的进展，右心室-肺动脉（PA）解耦，导致右心室衰竭。到目前为止，优化RV- pa耦合的策略主要集中在降低RV后负荷上，而增加RV收缩性的方法较少。在这里，我们提供了另一种观点，即在RV内的能量生产和机械工作之间存在另一种类型的“解耦”，这反映了收缩性（需求）和新陈代谢（供应）之间的竞争。这种解耦是PH下右心室心肌硬度增加以及能量产生减少的结果。我们建议通过降低刚度和增加能量容量来优化机械-能量解耦将是重要的，因为我们寻求针对失败的右心室来改善右心室- pa耦合并最终改善PH患者的预后。

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引用次数: 0

Rapid donor-specific single nucleotide variation detection by nanopore sequencing of ex vivo lung perfusate 体外肺灌注液纳米孔测序快速检测供体特异性单核苷酸变异

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-11-06 DOI: 10.1016/j.jhlto.2025.100433

Haruchika Yamamoto , Jonathan Allen , Adam Sundby , Philip Zuzarte , Shaf Keshavjee , Jared Simpson , Gavin W. Wilson , Jonathan C. Yeung MD, PhD, FRCSC

Background

Donor-derived cell-free DNA (ddcfDNA) has been shown to be useful in monitoring lung graft health, and single nucleotide variations (SNVs) between donor and recipient are used to identify ddcfDNA in post-transplant recipient blood. One limitation is the need to map donor or recipient SNVs prior to calculating %ddcfDNA. In this study, we use Nanopore sequencing of ex vivo lung perfusion perfusate cfDNA to map donor SNVs and validate it using standard short-read whole genome sequencing (WGS). Methods: cfDNA was extracted from 11 clinical ex vivo lung perfusion perfusate samples and sequenced using a Nanopore sequencer. SNVs were identified by comparison to a reference genome and then filtered for homozygous calls overlapping the 1000 Genomes SNP database. Matching short-read WGS was performed on 6 matching samples to act as a gold standard. Following mapping, %ddcfDNA was calculated in cell-free DNA (cfDNA) collected from matching post-lung transplant recipient plasma using SNVs called by Nanopore vs SNVs called by short-read WGS and compared for accuracy.

Results

Nanopore sequencing yielded genomic data with a median coverage of 4.88x (range 2.27-8.79) using a single flow cell with a median run length of 72 hours. The median general error rate of the sequence was 5.55% (range 4.98%-6.49%), and the median number of SNV with a depth > 3 and overlap with the 1000 Genomes SNP database was 246,993 (range 99,357-313,721). The positive predictive value of SNVs identified using 2X to 6X coverage cutoffs ranged from 66.6% to 96.9%, with a median value of 90.3% at 6X coverage. Correlation analysis showed a strong correlation between results by Nanopore sequencing and results by WGS for detecting %ddcfDNA in post-transplant plasma (R^2 = 0.996, p < 0.001).

Conclusions

Despite the lower sequencing accuracy and depth obtained from Nanopore sequencing, a high positive predictive value can be achieved in a set of donor-specific SNVs when appropriately filtered by read depth and overlap with SNP databases. This demonstrates the potential for the use of Nanopore sequencing to generate personalized donor cfDNA maps for use in post-operative donor-derived plasma cfDNA identification.

供体来源的无细胞DNA （ddcfDNA）已被证明可用于监测肺移植健康，供体和受体之间的单核苷酸变异（snv）可用于鉴定移植后受体血液中的ddcfDNA。一个限制是需要在计算%ddcfDNA之前绘制供体或受体snv。在这项研究中，我们使用体外肺灌注cfDNA的纳米孔测序来绘制供体snv，并使用标准短读全基因组测序（WGS）对其进行验证。方法：从11例临床离体肺灌注标本中提取cfDNA，采用纳米孔测序仪进行测序。通过与参考基因组的比较鉴定snv，然后筛选与1000个基因组SNP数据库重叠的纯合调用。对6个配对样品进行配对短读WGS作为金标准。定位后，使用纳米孔（Nanopore）和短读WGS （short-read WGS）的snv计算从匹配的肺移植后受体血浆中收集的无细胞DNA （cfDNA）的%ddcfDNA，并比较其准确性。结果纳米孔测序获得的基因组数据中位数覆盖率为4.88x（范围2.27-8.79），使用单个流式细胞，平均运行时间为72小时。序列总体错误率中位数为5.55%（范围4.98% ~ 6.49%），与1000 Genomes SNP数据库重叠深度>； 3的SNV中位数为246,993个（范围99,357 ~ 313,721个）。使用2X到6X覆盖率临界值确定的snv阳性预测值范围从66.6%到96.9%，在6X覆盖率下的中位数为90.3%。相关分析显示，纳米孔测序结果与WGS检测移植后血浆中%ddcfDNA的结果具有很强的相关性（R^2 = 0.996, p < 0.001）。结论尽管纳米孔测序获得的测序精度和深度较低，但通过适当的读取深度过滤并与SNP数据库重叠，可以在一组供体特异性snv中获得较高的阳性预测值。这证明了使用纳米孔测序生成个性化供体cfDNA图谱的潜力，可用于术后供体来源血浆cfDNA鉴定。

{"title":"Rapid donor-specific single nucleotide variation detection by nanopore sequencing of ex vivo lung perfusate","authors":"Haruchika Yamamoto , Jonathan Allen , Adam Sundby , Philip Zuzarte , Shaf Keshavjee , Jared Simpson , Gavin W. Wilson , Jonathan C. Yeung MD, PhD, FRCSC","doi":"10.1016/j.jhlto.2025.100433","DOIUrl":"10.1016/j.jhlto.2025.100433","url":null,"abstract":"<div><h3>Background</h3><div>Donor-derived cell-free DNA (ddcfDNA) has been shown to be useful in monitoring lung graft health, and single nucleotide variations (SNVs) between donor and recipient are used to identify ddcfDNA in post-transplant recipient blood. One limitation is the need to map donor or recipient SNVs prior to calculating %ddcfDNA. In this study, we use Nanopore sequencing of ex vivo lung perfusion perfusate cfDNA to map donor SNVs and validate it using standard short-read whole genome sequencing (WGS). Methods: cfDNA was extracted from 11 clinical ex vivo lung perfusion perfusate samples and sequenced using a Nanopore sequencer. SNVs were identified by comparison to a reference genome and then filtered for homozygous calls overlapping the 1000 Genomes SNP database. Matching short-read WGS was performed on 6 matching samples to act as a gold standard. Following mapping, %ddcfDNA was calculated in cell-free DNA (cfDNA) collected from matching post-lung transplant recipient plasma using SNVs called by Nanopore vs SNVs called by short-read WGS and compared for accuracy.</div></div><div><h3>Results</h3><div>Nanopore sequencing yielded genomic data with a median coverage of 4.88x (range 2.27-8.79) using a single flow cell with a median run length of 72 hours. The median general error rate of the sequence was 5.55% (range 4.98%-6.49%), and the median number of SNV with a depth > 3 and overlap with the 1000 Genomes SNP database was 246,993 (range 99,357-313,721). The positive predictive value of SNVs identified using 2X to 6X coverage cutoffs ranged from 66.6% to 96.9%, with a median value of 90.3% at 6X coverage. Correlation analysis showed a strong correlation between results by Nanopore sequencing and results by WGS for detecting %ddcfDNA in post-transplant plasma (R^2 = 0.996, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Despite the lower sequencing accuracy and depth obtained from Nanopore sequencing, a high positive predictive value can be achieved in a set of donor-specific SNVs when appropriately filtered by read depth and overlap with SNP databases. This demonstrates the potential for the use of Nanopore sequencing to generate personalized donor cfDNA maps for use in post-operative donor-derived plasma cfDNA identification.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100433"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intermediate-term risk of cardiac allograft vasculopathy following heart transplantation from hepatitis C viremic donors in the era of direct-acting antiviral therapy 直接作用抗病毒治疗时代丙型肝炎病毒血症供者心脏移植后发生同种异体心脏血管病变的中期风险

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-10-25 DOI: 10.1016/j.jhlto.2025.100416

K. Paternostro, A. Birs, S. Aslam, E. Adler, K. Hong, N. Wettersten

Background

Cardiac allograft vasculopathy (CAV) is a leading cause of death in heart transplant (HTx) recipients. Chronic hepatitis C virus (HCV) infection has been associated with increased inflammation and accelerated CAV. The advent of direct-acting antiviral (DAA) therapy has renewed interest in transplanting HCV-viremic donors, though long-term outcomes remain limited.

Methods

We conducted a single-center retrospective study of adult HTx recipients at UC San Diego from 2015 to 2019 who underwent routine intravascular ultrasound (IVUS) surveillance. Recipients were stratified by donor HCV nucleic acid amplification test (NAT) status. Donor-derived HCV infection was treated with DAA therapy. We used multivariable-adjusted Cox regression to evaluate the primary endpoint of developing CAV, defined as maximal intimal thickness (MIT) ≥ 0.5 mm, and endpoints of MIT ≥ 0.7 mm and a composite outcome of incident acute coronary syndrome, percutaneous coronary intervention (PCI), and all-cause mortality.

Results

Among 131 recipients, 22 received HCV NAT+ hearts. Baseline donor and recipient characteristics were similar, except for recipients of HCV NAT- hearts were younger (53.7 years vs 61.0 years; P = 0.022). Over a median follow-up of 6.6 years, HCV NAT+ status was not associated with a higher risk of CAV (MIT ≥ 0.5 mm: adjusted HR 0.89, 95% confidence interval (CI), 0.52-1.53; p = 0.673; MIT ≥ 0.7 mm: adjusted HR 0.91, 95% CI 0.51-1.61; p = 0.750), nor the composite outcome (adjusted HR 1.23, 95% CI, 0.45-3.40; p = 0.690).

Conclusion

In the modern DAA era, transplantation of HCV NAT+ donor hearts is not associated with increased risk of CAV or adverse clinical outcomes over intermediate-term follow-up.

背景：同种异体心脏移植血管病变（CAV）是心脏移植（HTx）受者死亡的主要原因。慢性丙型肝炎病毒（HCV）感染与炎症增加和CAV加速有关。直接抗病毒（DAA）疗法的出现重新引起了人们对移植hcv病毒血症供体的兴趣，尽管长期结果仍然有限。方法对2015年至2019年在加州大学圣地亚哥分校接受常规血管内超声（IVUS）监测的成人HTx受体进行单中心回顾性研究。根据供体HCV核酸扩增试验（NAT）状态对受体进行分层。供体源性HCV感染采用DAA治疗。我们使用多变量校正Cox回归来评估发生CAV的主要终点，定义为最大内膜厚度(MIT)≥0.5 mm, MIT≥0.7 mm的终点，以及突发急性冠状动脉综合征、经皮冠状动脉介入治疗（PCI）和全因死亡率的复合终点。结果131例患者中，22例接受了HCV NAT+心脏移植。基线供体和受体特征相似，除了HCV NAT受体更年轻（53.7岁vs 61.0岁；P = 0.022）。在6.6年的中位随访中，HCV NAT+状态与CAV的高风险无关(MIT≥0.5 mm：调整后风险比0.89,95%可信区间（CI）， 0.52-1.53；p = 0.673；MIT≥0.7 mm：调整后HR 0.91, 95% CI 0.51-1.61；p = 0.750)，也没有综合结果（调整后危险度1.23,95% CI, 0.45-3.40; p = 0.690）。结论在现代DAA时代，在中期随访中，HCV NAT+供体心脏移植与CAV风险增加或不良临床结果无关。

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引用次数: 0

Abnormal spirometry 1 year after lung transplantation may identify patients at risk for chronic lung allograft dysfunction in a multicenter cohort 在一项多中心队列研究中，肺移植后1年异常肺活量测定可识别有慢性同种异体肺移植功能障碍风险的患者

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-12-23 DOI: 10.1016/j.jhlto.2025.100473

Alexander R. Graham MD, MHS , Maria V. Grau-Sepulveda MD, MPH , Jamie L. Todd MD, MHS , Megan L. Neely PhD , Laurie D. Snyder MD, MHS

Background

Baseline lung allograft dysfunction (BLAD) is the failure to achieve predicted pulmonary function after lung transplantation. BLAD, as defined by abnormal spirometry at 12 months post-transplant (Spiro12M), has been associated with increased mortality and chronic lung allograft dysfunction (CLAD) in a single-center study. We sought to validate Spiro12M in a prospective multicenter study that included bilateral (BLTx) and single (SLTx) lung recipients.

Methods

The cohort included first lung recipients from 5 North American transplant centers participating in the Clinical Trials in Organ Transplantation-20 study. Abnormal Spiro12M was defined as a percent predicted forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC) at 12 months post-transplant <80% predicted based on recipient demographics, or FEV1/FVC <0.7. A modified Spiro12M definition was separately analyzed whereby recipients met at least 2 criteria. Cox regression models assessed the primary endpoints of time to probable CLAD, probable CLAD composite (including CLAD-related death/retransplantation), obstructive CLAD, or graft loss (death/retransplantation).

Results

517 patients met inclusion criteria, with 229 (60.4%) BLTx and 109 (79.0%) SLTx recipients having abnormal Spiro12M. Among BLTx, abnormal Spiro12M was associated with an increased risk of probable CLAD composite (HR, 1.58; 95% CI, 1.09, 2.29; p = 0.015), while modified Spiro12M was associated with probable CLAD (HR, 1.70; 95% CI, 1.15, 2.52; p = 0.008), probable CLAD composite (HR, 1.82; 95% CI, 1.25, 2.65; p = 0.002), and graft loss (HR, 1.68; 95% CI, 1.14, 2.48; p = 0.009).

Conclusions

Spiro12M and modified Spiro12M are reproducible, clinically relevant definitions that can prospectively identify BLTx at risk for CLAD.

基线肺同种异体移植功能障碍（BLAD）是指肺移植后肺功能未能达到预期的水平。在一项单中心研究中，移植后12个月肺活量异常（Spiro12M）所定义的BLAD与死亡率增加和慢性同种异体肺移植功能障碍（CLAD）相关。我们试图在一项包括双侧（BLTx）和单侧（SLTx）肺受体的前瞻性多中心研究中验证Spiro12M。方法该队列包括来自北美5个器官移植中心参加器官移植临床试验-20研究的首次肺受者。Spiro12M异常定义为移植后12个月预测的1秒用力呼气量（FEV1）或用力肺活量（FVC）的百分比；80%基于受者人口统计学预测，或FEV1/FVC <；0.7。单独分析修改后的Spiro12M定义，其中接受者至少满足2个标准。Cox回归模型评估了可能发生的覆层损伤、复合覆层损伤（包括与覆层损伤相关的死亡/再移植）、阻塞性覆层损伤或移植物损失（死亡/再移植）的主要时间终点。结果517例患者符合纳入标准，其中BLTx患者229例（60.4%），SLTx患者109例（79.0%）Spiro12M异常。在BLTx患者中，异常的Spiro12M与可能的复合层合的风险增加相关（HR, 1.58, 95% CI, 1.09, 2.29, p = 0.015），而改良的Spiro12M与可能的复合层合（HR, 1.70, 95% CI, 1.15, 2.52, p = 0.008），可能的复合层合（HR, 1.82, 95% CI, 1.25, 2.65, p = 0.002）和移植损失相关（HR, 1.68, 95% CI, 1.14, 2.48, p = 0.009）。结论Spiro12M和改良的Spiro12M是可重复的、临床相关的定义，可以前瞻性地识别有CLAD风险的BLTx。

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引用次数: 0

Time to let go of the biopsy? A new era in cardiac rejection monitoring? 是时候放弃活检了吗？心脏排斥反应监测的新时代？

JHLT Open

Pub Date : 2026-02-01 Epub Date: 2025-12-31 DOI: 10.1016/j.jhlto.2025.100478

H. Eiskjaer MD, DMSc, M.J. Andersen MD, PhD, T.S. Clemmensen MD, PhD, DMSc

引用次数: 0