Trasplante cardíaco

BMJ Case Rep. 2025 Jul 1;18(7):e265384. doi: 10.1136/bcr-2025-265384.

ABSTRACT

Viral infections have been associated with acute allograft rejection in solid organ transplant recipients. Influenza infection upregulates host proinflammatory cytokines, suggesting the host immune response can precipitate graft rejection. Pandemic influenza, specifically, was associated with rejection in multiple renal allograft recipients. However, cardiac allograft rejection has not been reported in association with endemic influenza. We present the case of a man in his mid-30s, transplanted 5 years prior, who developed new heart failure 4 weeks after PCR-confirmed influenza A infection. Endomyocardial biopsy revealed concomitant high-grade acute cellular rejection and antibody-mediated rejection. Despite a pretransplant panel reactive antibody of 0%, a negative virtual crossmatch and consistently therapeutic tacrolimus levels, de novo donor-specific antibodies developed. Even with aggressive therapy, he died as a result of graft failure. Transplant recipients must be regularly vaccinated, and clinicians should maintain a high degree of suspicion of graft failure in the immediate aftermath of influenza infection.

PMID:40592589 | DOI:10.1136/bcr-2025-265384

J Heart Lung Transplant. 2025 Jun 24:S1053-2498(25)02036-4. doi: 10.1016/j.healun.2025.06.011. Online ahead of print.

ABSTRACT

BACKGROUND: The forced expiratory volume in one second (FEV1) is the standard measure used to monitor the lung function after lung transplantation. However, little is known about the FEV1 trajectories post transplantation, and their associations with clinical outcomes.

METHODS: Adult patients who received a bilateral lung transplant between January 1, 2010 and January 1, 2021 were included from 15 centres in France, Belgium, Austria and the US. Three French centres formed the development cohort and the remaining centres formed the external validation cohorts. All centres performed routine spirometry measurements commencing shortly after lung transplantation and continuing at regular intervals of maximum three months afterwards. Recipient, donor and transplant characteristics were collected. Latent class mixed models were used to identify FEV1 trajectories. The number of FEV1 trajectories was defined according to the Akaike Information Criterion, Bayesian Information Criterion, the discrimination, the entropy and the interpretability of the model.

FINDINGS: A total of 2305 patients were included with 59 034 FEV1 measurements collected. The median follow-up post-transplantation was 4.3 years (IQR 2.3-6.2). In the development cohort (n=605), the best latent class mixed model identified seven clinically meaningful FEV1 trajectories. Trajectory #1 (25.6%) was characterized by patients with moderate and stable lung function (3-year patient survival = 79.9%); trajectory #2 (24.0%) and #3 (27.3%) were characterized by patients with moderate/high and stable lung function (3-year patient survival = 96.6% and 95.7% respectively); trajectory #4 (3.8%) was characterized by patients with increasing lung function (3-year patient survival = 69.6%); trajectory #5 (11.7%) was characterized by patients with a slow decline (3-year patient survival = 90.1%); and trajectory #6 (3.0%) and #7 (4.6%) were characterized by patients with accelerated decline (3-year patient survival = 33.3% and 59.5 % respectively). Patients belonging to trajectories were associated with gender (p=0.020) and underlying disease (p=0.004). Similar FEV1 trajectories and patient outcomes were identified in the external validation cohorts on the basis of independent analyses. The trajectories were also confirmed in a series of subpopulations. Last, FEV1 value and slope at 1 year post transplant were strongly associated with FEV1 trajectories, in both the development cohort and the external validation cohorts.

INTERPRETATION: We identified and validated FEV1 trajectories that capture different clinical scenarios associated with post-transplant recipient outcomes. Our results may provide the basis for a trajectory-based risk assessment of lung transplant recipients.

FUNDING: "Vaincre la mucoviscidose" grant, the association Grégory Lemarchal, ANR grant, PHRC grant, the FP7 collaborative project, IRSRPL grant, the Fondation du Souffle and PLUTO DITCAP grant from Vaincre la Mucoviscidose and Association Grégory Lemarchal.

PMID:40592371 | DOI:10.1016/j.healun.2025.06.011

Proc Natl Acad Sci U S A. 2025 Jul 8;122(27):e2424529122. doi: 10.1073/pnas.2424529122. Epub 2025 Jul 1.

ABSTRACT

Mitochondrial dysfunction is closely linked to cardiomyocyte injury following myocardial infarction (MI). While mitochondrial transplantation is a promising therapeutic strategy, challenges remain in maintaining mitochondrial structural integrity, enhancing delivery efficiency, and increasing the mitochondrial supply. Herein, we developed a gelated microvesicle-based mitochondria delivery system (Mito@Microgels) for transplanting mesenchymal stem cell mitochondria, addressing the aforementioned issues. Further decoration of phosphatidylserine on the surface of Mito@Microgels boosted cellular uptake efficiency by cardiomyocytes. These Mito@Microgels effectively deliver active mitochondria to cardiomyocytes, improving the mitochondrial network architecture and function and consequently reducing the cellular injury induced by oxidative stress. Moreover, Mito@Microgels attenuated the inflammatory phenotype of macrophages, helping resolve excessive local inflammation. In vivo animal studies using a rat MI model further validated the therapeutic efficacy of the Mito@Microgels, as evidenced by improved myocardial function, prevention of infarcted left ventricular wall thinning, and increased cardiomyocyte survival. Our study introduces an efficient mitochondrial delivery strategy with significant potential for cardiac repair post-MI and other mitochondria-related diseases.

PMID:40591606 | DOI:10.1073/pnas.2424529122

Support Care Cancer. 2025 Jul 1;33(7):646. doi: 10.1007/s00520-025-09706-0.

ABSTRACT

PURPOSE: Social support can ameliorate the challenges faced by childhood cancer survivors and their parents as survivors transition into adulthood. This study examined social support dynamics within adolescent/young adult (AYA)-parent dyads by comparing their support needs and gaps.

METHODS: This qualitative study was conducted in collaboration with a community-based organization serving predominately socioeconomically disadvantaged, Hispanic/Latino (H/L), rural families affected by childhood cancer in California. English- and Spanish-speaking AYA childhood cancer survivors (≥ 15 years old, ≥ 5 years from diagnosis) and parents were interviewed. Transcripts were analyzed qualitatively using applied thematic analysis.

RESULTS: Seven AYA-parent dyads (six H/L and bilingual or Spanish speaking only) were interviewed. AYAs (six male, one female) had a median (min-max) age of 19 (16-23) and were 14 years post-diagnosis (6-17). Forms of social support fell into emotional, instrumental (i.e., tangible assistance), and informational domains. Family and faith were shared sources of emotional support for parents and AYAs. Although AYAs identified parents as consistent sources of emotional support, parents frequently discussed inadequate family support and unmet emotional needs. Parents also more commonly discussed gaps in instrumental support. AYAs often lacked cancer-related knowledge, with parents serving as primary sources of informational support. Parents worried about children's readiness to transition to adult-focused survivorship care.

CONCLUSION: Parents experienced gaps in emotional and instrumental support not noted by AYAs, suggesting parents help buffer these experiences. AYAs' reliance on parents for informational support in the post-treatment period highlights an opportunity to build upon supportive parent-AYA relationships through dyad-focused education to facilitate adult-focused survivorship care transitions.

PMID:40591011 | DOI:10.1007/s00520-025-09706-0

J Clin Invest. 2025 Jul 1;135(13):e172218. doi: 10.1172/JCI172218. eCollection 2025 Jul 1.

ABSTRACT

Coinhibitory receptors function as central modulators of the immune response to resolve T effector activation and/or to sustain immune homeostasis. Here, using humanized SCID mice, we found that neuropilin-2 (NRP2) is inducible on late effector and exhausted subsets of human CD4+ T cells and that it is coexpressed with established coinhibitory molecules including PD-1, CTLA4, TIGIT, LAG3, and TIM3. In murine models, we also found that NRP2 is expressed on effector memory CD4+ T cells with an exhausted phenotype and that it functions as a key coinhibitory molecule. Knockout (KO) of NRP2 resulted in hyperactive CD4+ T cell responses and enhanced inflammation in delayed-type hypersensitivity and transplantation models. After cardiac transplantation, allograft rejection and graft failure were accelerated in global as well as CD4+ T cell-specific KO recipients, and enhanced alloimmunity was dependent on NRP2 expression on CD4+ T effectors but not on CD4+Foxp3+ Tregs. Also, KO Tregs were found to be as efficient as WT cells in the suppression of effector responses in vitro and in vivo. These collective findings identify NRP2 as a potentially novel coinhibitory receptor and demonstrate that its expression on CD4+ T effector cells is of great functional importance in immunity.

PMID:40590224 | DOI:10.1172/JCI172218

Transplant Direct. 2025 Jun 27;11(7):e1828. doi: 10.1097/TXD.0000000000001828. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Despite treatment of major risk factors such as acute rejection (AR) and organizing pneumonia (OP) in lung transplant recipients, chronic lung allograft dysfunction (CLAD) still develops at high rates, suggesting that traditional methods of assessing response to treatment and resolution remain inadequate. It is unknown whether the degree of molecular allograft injury after treatment of AR/OP modulates the risk of CLAD and death.

METHODS: To evaluate the association of molecular allograft injury after AR/OP with the incidence of CLAD/death, we conducted a multicenter prospective cohort study that included 93 patients who underwent lung transplantation between 2015 and 2022. The degree of molecular allograft injury after AR/OP was quantified by the mean area under the curve of longitudinal measures of plasma donor-derived cell-free DNA (dd-cfDNA).

RESULTS: Over a median follow-up of 5 y, patients who developed CLAD/death had persistently higher levels of dd-cfDNA in the months after AR/OP. In multivariable Cox regression analysis adjusting for patient and transplant risk factors, mean dd-cfDNA levels after AR/OP were independently associated with an increased risk of CLAD/death (adjusted hazard ratio, 2.84; 95% confidence interval, 1.67-4.83; P < 0.001) and remained consistent when accounting for changes in pulmonary function after AR/OP events (hazard ratio, 2.62; 95% confidence interval, 1.53-4.47; P < 0.001).

CONCLUSIONS: The degree of allograft injury on the molecular level after AR/OP events in lung transplant recipients is associated with the risk of developing CLAD or death. This study demonstrates the potential of dd-cfDNA for improving risk stratification and monitoring the resolution and treatment responses of lung allograft injury.

PMID:40590009 | PMC:PMC12208644 | DOI:10.1097/TXD.0000000000001828

Cureus. 2025 May 31;17(5):e85141. doi: 10.7759/cureus.85141. eCollection 2025 May.

ABSTRACT

Chagas cardiomyopathy is a rare but critical cause of nonischemic heart failure, particularly in patients from endemic regions. We present a 48-year-old Spanish-speaking male from Guatemala with hypertension, hyperlipidemia, and heart failure with reduced left ventricular ejection fraction (LVEF, 10%) due to Chagas disease. Despite guideline-directed medical therapy and implantable cardioverter-defibrillator (ICD) placement, he developed cardiogenic shock. Right heart catheterization confirmed severely reduced cardiac output and elevated wedge pressure. He was ineligible for heart transplantation due to limited life expectancy but had no contraindications to left ventricular assist device (LVAD) placement. Following infectious disease clearance and prophylaxis for Trypanosoma cruzi, he successfully underwent LVAD implantation. At one-month follow-up, he showed clinical stability, improved symptoms, and adherence to medical therapy. Our case discusses the role of LVAD as a life-extending option in Chagas cardiomyopathy for non-transplant candidates, emphasizing the importance of multidisciplinary care in managing both cardiac and infectious components.

PMID:40589690 | PMC:PMC12208515 | DOI:10.7759/cureus.85141

Xenotransplantation. 2025 Jul-Aug;32(4):e70063. doi: 10.1111/xen.70063.

ABSTRACT

BACKGROUND: Solid organ xenotransplantation has been approved for clinical trials in the United States. Because of the role of nurses in patient decision-making, it is important to understand the attitudes of the future nursing workforce toward xenotransplantation. This pilot study aimed to investigate the attitudes of adult nursing students toward xenotransplantation.

METHODS: A cross-sectional survey design was used. The online pilot survey was completed by 33 undergraduate adult nursing students at one university in London, England. A minority of the hospitals that students may have had a clinical placement in had a transplant unit. The protocol for this study was reviewed and approved by the university research ethics panel.

RESULTS: Fifty-two percent of students viewed xenotransplantation positively when the risks and outcomes were equal to allotransplantation. Students were most positive toward accepting a liver from an animal source and the most negative toward accepting a heart. There was limited concern about the potential psychosocial effects of xenotransplantation. Students believed that xenotransplantation involved several risks, including immunologic, infection, and raising religious, ethical, and philosophical problems.

CONCLUSION: While participants had a moderately positive view toward xenotransplantation when the risks and outcomes were equal to allotransplantation-this dropped significantly if it produced worse outcomes. Their primary concerns about xenotransplantation were its potential infection risks as well as the ethical, philosophical, and religious problems it raises. The fact that the source organs are genetically engineered made students view xenotransplantation more favorably.

PMID:40589138 | PMC:PMC12209689 | DOI:10.1111/xen.70063

Xenotransplantation. 2025 Jul-Aug;32(4):e70061. doi: 10.1111/xen.70061.

ABSTRACT

Xenotransplantation is becoming an emerging field of interest for the treatment of end-stage heart disease. In fact, the shortage of human heart donors in European countries requires the increasing investigation of alternative strategies such as heart xenotransplantation. Among different limitations in this peculiar field, the experimental pharmacological management of patients who undergo heart xenotransplantation is primarily narrowed by the indications for which these drugs have been previously authorized by international medicines agencies. In fact, many of these medications have been never authorized for transplant rejection therapy, or for xenotransplantation, but their mechanism of action might stop the molecular pathways which are involved in xenograft antibody-mediated rejection. Additionally, drugs costs and supply can restrict their availability for xenotransplantation practice. The aim of this review is to describe the current drugs which have been used in the clinical cases of heart xenotransplantation performed to date, to analyze the indications for which they are authorized, and to evaluate the future medications which might be implemented in heart xenotransplantation field, with a particular focus on the European scenario.

PMID:40589132 | PMC:PMC12209706 | DOI:10.1111/xen.70061

Stud Health Technol Inform. 2025 Jun 26;328:298-301. doi: 10.3233/SHTI250723.

ABSTRACT

Transplantation surgery has grown significantly over the years, from conventional procedures to minimally invasive and robotic-assisted surgery. While traditional methods, are still essential for emergency situations, they often result in longer recovery times, increased patient pain, and higher complication risks. However, robotic-assisted surgery, improves the experience by offering enhanced precision, improved visualization, and reduced surgery invasiveness, thus contributing to shorter recovery periods, less blood loss, and fewer complications for patients. This proceeding aims to explore the integration of robotic systems in transplant surgeries in Saudi Arabia, focusing on the country's recent groundbreaking achievements, such as the world's first fully robotic heart and liver lobe transplants performed at King Faisal Specialist Hospital & Research Centre. Additionally, discusses the advantages of robotic transplantation, such as improved surgical accuracy and patient outcomes, along with the possible challenges like costs, longer operating times, and the need for specialized training. The integration of robotic technology in transplant surgery aligns with Saudi Arabia's Vision 2030 healthcare transformation program, which attempts to advance healthcare services through technological innovations. Despite the challenges, robotic surgery has proven to be a transformative tool in the field of transplantation, offering both patients and surgeons significant benefits.

PMID:40588930 | DOI:10.3233/SHTI250723

Medicine (Baltimore). 2025 Jun 27;104(26):e43122. doi: 10.1097/MD.0000000000043122.

ABSTRACT

RATIONALE: To evaluate the effect of pharmaceutical care provided by clinical pharmacists during COVID-19 treated with nirmatrelvir/ritonavir in heart transplant (HT) patients.

PATIENT CONCERNS: Three HT recipients were admitted to the hospital after testing positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleic acid. Due to factors such as underlying immunosuppression resulting from the heart transplantation and the use of antirejection medications, patients who have undergone heart transplantation and become infected with SARS-CoV-2 exhibit significant differences in pathological responses and drug metabolism in the body compared to other patients. During the treatment period with nirmatrelvir/ritonavir, clinical pharmacists provided comprehensive pharmaceutical care for these patients throughout the course.

DIAGNOSES: After heart transplantation, testing positive for SARS-CoV-2 nucleic acid.

INTERVENTIONS: During the treatment of the 3 patients with nirmatrelvir/ritonavir for COVID-19, clinical pharmacists provided pharmaceutical care from aspects such as medication indications, dosage administration, drug adjustments, drug interactions, and adverse reaction monitoring, in order to develop individualized medication regimens for the patients.

OUTCOMES: Clinical pharmacists actively predicted, identified, and resolved issues that arose during the treatment of HT recipients with nirmatrelvir/ritonavir. They monitored the blood concentration of tacrolimus and the interactions between nirmatrelvir/ritonavir and other medications throughout the treatment process. All 3 patients were cured and discharged from the hospital.

LESSONS: During the treatment process, managing complex polypharmacy posed significant challenges. Clinical pharmacists implemented individualized therapeutic drug monitoring to optimize antiviral efficacy. Through rational and effective pharmaceutical care, the clinical cure rate for HT recipients infected with COVID-19 was improved.

PMID:40587671 | PMC:PMC12212775 | DOI:10.1097/MD.0000000000043122

J Vis Exp. 2025 Jun 13;(220). doi: 10.3791/68349.

ABSTRACT

Although significant progress has been made in heart transplantation, issues such as graft preservation, primary graft dysfunction, cardiac allograft vasculopathy, and long-term immune tolerance remain unresolved. Due to anatomical size and immunological differences, mouse models are unable to effectively replicate clinical heart transplantation surgeries and immune responses. In contrast, pig models, which share more similarities with humans in terms of heart anatomy and immune response, are particularly suitable for orthotopic heart transplantation research. In this study, we established a biatrial orthotopic heart transplantation model in Bama miniature pigs. The transplanted hearts demonstrated prompt and robust contractility postoperatively without signs of elevated central venous pressure or other hemodynamic complications. Following a short period of intensive care unit monitoring, the pigs regained consciousness and resumed spontaneous feeding, indicating stable postoperative recovery. In summary, this model offers a clinically relevant experimental platform for evaluating new technologies and therapeutic approaches in the field of heart transplantation research.

PMID:40587422 | DOI:10.3791/68349

Natl Med J India. 2025 Mar-Apr;38(2):94-95. doi: 10.25259/NMJI_336_2023.

ABSTRACT

Infective endocarditis (IE) is caused by viral, bacterial or fungal pathogens, with high morbidity and mortality. Fungal endocarditis is rare and is associated with severe complications with poor prognosis despite combined medical and surgical treatment. Although Candida albicans is the most common fungal agent of this severe form of endocarditis, Candida parapsilosis is the most common non-albicans causative species. A 17-year-old patient who had had a liver transplant was referred to our paediatric cardiovascular surgery ward with a diagnosis of right heart failure. He had had coronary artery bypass graft and aortic valve replacement in 2021. He came to the outpatient clinic with complaints of fever, weakness, nausea and vomiting. On physical examination, he had pallor, dyspnoea and tachycardia. His fever was 38 °C and a grade 2/6 systolic ejection murmur was detected on auscultation. Amphotericin B in a dose of 4 mg/kg/day was started based on the antifungal sensitivity test.

PMID:40587274 | DOI:10.25259/NMJI_336_2023

CJC Open. 2025 Mar 24;7(6):813-820. doi: 10.1016/j.cjco.2025.03.015. eCollection 2025 Jun.

ABSTRACT

Clinical characteristics of progressive heart failure warranting advanced heart failure (AHF) therapies are not well defined in patients with atypical cause-specific cardiomyopathies, as in conventional ischemic and dilated cardiomyopathies. Some of these specific cardiomyopathies are associated with systemic diseases, and the impact and the severity of extracardiac involvement is crucial in defining the appropriate choice of AHF therapies. This review focuses on special considerations in cause-specific cardiomyopathies, such as hypertrophic cardiomyopathy, cardiac sarcoidosis, cardiac amyloidosis, and arrhythmogenic right ventricular cardiomyopathy. The review evaluates AHF therapies, including heart transplantation and durable mechanical circulatory support devices, along with nuances in the management of these patients after they receive AHF therapies.

PMID:40586021 | PMC:PMC12198592 | DOI:10.1016/j.cjco.2025.03.015

Transpl Int. 2025 Jun 2;38:14153. doi: 10.3389/ti.2025.14153. eCollection 2025.

ABSTRACT

To address the shortage of organs for kidney transplantation, the Eurotransplant Senior Program (ESP) was established to enhance kidney allocation from elderly donors. This study aimed to evaluate post-transplant outcomes of deceased donor grafts and identify prognostic factors within the ESP population. We therefore analyzed patient data from 64 ESP recipients and their donors transplanted at our center between 2017 and 2022. Time-zero biopsies were analyzed using AI image analysis software for glomerular density and glomerulosclerosis. One-year patient and allograft survival rates were 96.9% and 85.9%. 5-year survival rate was 74.6%, as opposed to about 41.0% historically reported for patients on dialysis. Delayed Graft Function occurred in 29.7% of cases, with recipient coronary heart disease, BMI-disparities, and prolonged cold ischemia time as major predictors (P < 0.05). Histopathological analysis revealed that the degree of glomerulosclerosis and interstitial fibrosis and tubular atrophy (IFTA) were associated with graft failure in multivariable analyses (P < 0.05). Arteriolosclerosis (arteriolar hyalinosis) correlated with a higher risk for primary non-function (P < 0.05). The number of HLA mismatches was not significantly associated with graft outcome. Including prognostic baseline characteristics as well as histopathological AI analysis into individual allocation decisions during organ-acceptance process might improve allograft survival within the ESP and should prospectively be studied.

PMID:40585890 | PMC:PMC12203019 | DOI:10.3389/ti.2025.14153

Transpl Int. 2025 Jun 2;38:13971. doi: 10.3389/ti.2025.13971. eCollection 2025.

ABSTRACT

Normothermic ex-vivo organ perfusion (EVP) systems not only provide a physiological environment that preserves donor organ function outside the body but may also serve as platforms for ex-vivo organ modification via gene therapy. In this study, we demonstrated that a rationally designed muscle-tropic recombinant AAV, AAV-SLB101, delivered to the donor heart during brief normothermic EVP achieves durable cardiac transgene expression out to 90 and 120 days post-transplant in a porcine preclinical model. Moreover, transgene expression was detectable as early as 48 h post-transplant. Histological and MRI analyses of the donor myocardium showed no functional or structural impact on the allograft and no off-target gene expression in the recipient. This work will serve as a critical foundation to inform translational studies with therapeutic transgenes to improve allo-, xeno-, and auto-heart transplant outcomes.

PMID:40585889 | PMC:PMC12203020 | DOI:10.3389/ti.2025.13971

J Vasc Surg Cases Innov Tech. 2025 May 16;11(4):101844. doi: 10.1016/j.jvscit.2025.101844. eCollection 2025 Aug.

ABSTRACT

A 61-year-old female with previous liver transplantation was volume overloaded, requiring intubation and veno-venous extracorporeal membrane oxygenation. Workup was significant for mitral valve stenosis, for which she underwent repair. This was complicated by injury to the inferior vena cava with avulsion from the liver, which was reconstructed with bovine pericardium. Postoperatively, hemodynamic monitoring suggested poor venous return. She was taken for a venogram, demonstrating stenosis of the suprahepatic inferior vena cava, which was treated with placement of a bare metal self-expanding stent. This case report demonstrates an endovascular salvage technique for suprahepatic inferior vena cava stenosis after reconstruction during cardiac surgery.

PMID:40585579 | PMC:PMC12206025 | DOI:10.1016/j.jvscit.2025.101844

JHLT Open. 2025 May 27;9:100297. doi: 10.1016/j.jhlto.2025.100297. eCollection 2025 Aug.

ABSTRACT

Immunosuppression advances have enabled organ transplant recipients to consider parenthood, but pregnancy poses risks to maternal and fetal health. This systematic review examines pregnancy outcomes and immunosuppression management in cardiothoracic transplant recipients. We conducted a literature search of PubMed/Medline, Embase, and Maternity and Infant Care Database in December 2022. We identified 54 relevant studies and data from the Transplant Pregnancy Registry International, covering 404 pregnancies from 272 heart recipients (HTR) and 148 pregnancies from 121 lung recipients (LTR). Live births occurred in 74.3% of HTR and 65.5% of LTR pregnancies (22% preterm). Graft dysfunction developed in 11.5% (during) and 12.4% (after) of HTR pregnancies and 17.6% (during) and 18% (after) of LTR pregnancies. Other complications included hypertension (HTR: 36.9%, LTR: 58.8%), preeclampsia (HTR: 19.7%, LTR: 12.2%), and diabetes (HTR: 11%, LTR: 27%). Mortality was 17.4% for HTR and 26.5% for LTR. Half of HTR and two-thirds of LTR were on Tacrolimus. Common immunosuppression changes included discontinuation of Mycophenolate Mofetil, Azathioprine, or Sirolimus with corticosteroid dose adjustment. Despite high successful pregnancy rates, heart and lung transplant recipients may face substantial risks of graft dysfunction and maternal death post-pregnancy.

PMID:40584723 | PMC:PMC12205842 | DOI:10.1016/j.jhlto.2025.100297

JHLT Open. 2025 Jun 2;9:100288. doi: 10.1016/j.jhlto.2025.100288. eCollection 2025 Aug.

ABSTRACT

Post-myocardial infarction (MI) ventricular septal defects (VSDs) are rare but life-threatening. Temporary mechanical support options range from intra-aortic balloon pumps (IABPs) to venoarterial extracorporeal membrane oxygenation (VA-ECMO). There are few anecdotes of the Impella as a bridge to repair. We present a case of post-MI VSD and cardiogenic shock requiring combined Impella 5.5 and VA-ECMO (ECPELLA) as a bridge to transplant.

PMID:40584722 | PMC:PMC12205820 | DOI:10.1016/j.jhlto.2025.100288

JHLT Open. 2025 May 22;9:100277. doi: 10.1016/j.jhlto.2025.100277. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: We aim to describe the effect of belatacept on de novo donor-specific antibodies (DSA) formation, rejection, and renal function in heart transplant recipients.

METHODS: The cohort comprises 60 adult heart or heart-kidney recipients transplanted between 2005 and 2022. Twelve recipients initialized at ∼90 days post-transplantation on a belatacept-based immunosuppression regimen with tapered tacrolimus trough levels were matched to 48 standard tacrolimus-based regimen controls. Differences in the distribution of recipients with emergent de novo DSA and rejection were assessed over the first 85 days baseline period, the average duration pre-belatacept. Survival analysis assessed regimen group differences in the probability of remaining de novo DSA and rejection free over the follow-up period spanning 86 to 540 days. Renal function and cytomegalovirus viremia were examined as secondary outcomes.

RESULTS: There were no statistically significant regimen group differences in the distribution of recipients with de novo DSA or rejection during the baseline period. Furthermore, differences in the probability of remaining de novo DSA and rejection free during the follow-up period remained insignificant (log-rank test, p = 0.12). Belatacept-treated recipients, at follow-up, had no incidence of developing de novo DSA, unlike 19% of the controls. Additionally, there were no statistically significant differences in acute cellular and antibody mediated rejection events, renal function, and CMV viremia by regimen group.

CONCLUSION: Recipients treated with belatacept-based regimen exhibited a trend of reduced de novo DSA development compared to standard tacrolimus-based regimen controls. Larger studies are needed to evaluate the benefit of belatacept use in heart transplant populations.

PMID:40584719 | PMC:PMC12205671 | DOI:10.1016/j.jhlto.2025.100277