Trasplante cardíaco

Artif Organs. 2025 Jun 24. doi: 10.1111/aor.15035. Online ahead of print.

NO ABSTRACT

PMID:40552484 | DOI:10.1111/aor.15035

Future Cardiol. 2025 Jun 24:1-6. doi: 10.1080/14796678.2025.2521993. Online ahead of print.

ABSTRACT

Xenotransplantation is a promising advancement in the field of transplantation that could eliminate deaths on the waitlist and provide an unlimited supply of on-demand organs for those in need of this life-saving therapy. The results of preclinical studies in orthotopic heart xenotransplantation have shown that non-human primate models can consistently survive 9 months post-transplant. However, early clinical results in orthotopic heart xenotransplantation have been subpar compared to traditional orthotopic heart transplantation as the longest surviving patient survived for 60 days with a complicated postoperative course. Partial heart xenotransplantation could serve as an earlier clinical use case of xenotransplantation products due to the many advantages of the neonate and infant population for xenotransplantation as well as the unique immunogenicity of heart valves which is significantly lower than that of whole hearts. The adoption of partial heart xenotransplantation would allow more children to realize the benefits of a valve that tolerates somatic growth without the need for serial reoperation.

PMID:40552429 | DOI:10.1080/14796678.2025.2521993

Front Oncol. 2025 Jun 9;15:1568169. doi: 10.3389/fonc.2025.1568169. eCollection 2025.

ABSTRACT

Acquired aplastic anemia (AA) is a bone marrow failure syndrome characterized by pancytopenia and decreased hematopoietic stem and progenitor cells (HSPCs) in the bone marrow, it can be either congenital or acquired, predominantly affecting adolescents and the elderly, with higher incidence in Asia compared to Europe and America. Current treatment options include allogeneic hematopoietic stem cell transplantation or immunosuppressive agents, yet proximately a third of patients fail to reach long-term survival. AA is primarily driven by immune-mediated destruction of HSPCs, initiated by self-activated T cells. Early stages feature a Th1 response, which later shifts to Th17 and effector memory CD8+ T cells. Key cytokines including interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) play crucial roles in this immune dysregulation, influencing HSPCs and contributing to bone marrow failure. Furthermore, bone marrow macrophages (MΦ), particularly M1 subtype, are implicated in AA via the TNF-α/TNF-α receptor pathway, leading to T cell activating and subsequent HSPC damage. Interestingly, MΦ with high expression of IL-27Ra have been demonstrated to contribute to HSPC destruction in AA murine models. Beyond their role in thrombosis, platelets also participate in immune regulation. Some studies suggest that platelet may modulate T cell responses through mechanisms such as Akt-PGC1α-TFAM pathway or PF4-mediated activity, which could play a role in AA. However, direct evidence connecting platelet regulation to T cell-mediated HSPC damage is limited, and current research has largely focuses on CD8+ T cells. Moving forward, it is essential to investigate the interactions between platelets, CD4+ T cells, and mitochondrial energy metabolism. In this review, we propose that platelet-derived factors such as PF4 and TGFβ may activate mitochondrial pathways, influencing T cell activation and leading to HSPC destruction in AA. This hypothesis could provide new insights into the molecular mechanisms of AA and pave the way for novel therapeutic strategies (Highlight).

PMID:40552264 | PMC:PMC12183292 | DOI:10.3389/fonc.2025.1568169

Xenotransplantation. 2025 May-Jun;32(3):e70058. doi: 10.1111/xen.70058.

ABSTRACT

INTRODUCTION: Xenotransplantation has emerged as a promising solution to organ shortage, generating numerous publications. However, no studies have analyzed the research dynamics of xenotransplantation research. We aimed to systematically assess xenotransplantation publication activity.

METHODS: A systematic literature search was conducted up to November 22, 2024. Studies on xenotransplantation of solid organs and islets of Langerhans from animals to humans, or perfusion with human blood or its derivatives were included. Publication information, publishing journal, publication type, organ, donor species, and topics studied were extracted.

RESULTS: Of 2944 publications, 706 met inclusion criteria: 41.2% original articles, 41.1% reviews, 14.2% publications without original data, 1.6% case reports, 1.3% research letters, 0.6% systematic reviews/meta-analyses. Publication activity displayed two peaks: in the 1990s, driven by the gene editing advancements, and in the early 2020s, following the first pig-to-human transplantation. The top five publishing countries were the USA with (48.2%), Germany (10.2%), UK (5.4%), Sweden (4.8%), and China (4.2%). Xenotransplantation journal accounted for 19.7% of publications, transplantation journals for 27.6%, and general medical journals for 5.4%. Islets of Langerhans were studied in 23.1% of studies, and the most studied organs were heart (21.2%), followed by kidney (17.1%), liver (12.2%), and lung (6.2%). The most represented thematic groups were rejection, immune mechanisms, overall challenges, gene editing, current research, and prospects.

CONCLUSION: This first systematic assessment of xenotransplantation research highlights its growing global interest and evolving focus areas. The low proportion of publications with original data underscores the need for more original research. Limited representation in general medical journals highlights the importance of engaging a broader audience as clinical trials approach.

PMID:40551623 | DOI:10.1111/xen.70058

BMC Nephrol. 2025 Jun 23;26(1):290. doi: 10.1186/s12882-025-04264-3.

ABSTRACT

BACKGROUND: Chronic kidney disease represents an immunocompromising condition and a cause of a lower vaccine efficacy, even in patients undergoing maintenance dialysis. Recent SARS-CoV-2 outbreaks have prompted clinicians to better understand the underlying mechanisms and establish more suitable vaccination schedules.

METHODS: In a single-center, retrospective, observational study of patients undergoing maintenance dialysis in France, we studied the factors associated with the intensity of the humoral response to a SARS-CoV-2 vaccine in this population, including specific dialysis-related variables.

RESULTS: After having received three doses of SARS-CoV-2 mRNA vaccine, a cohort of 80 patients was divided into low-responders (28 patients with an anti-SARS-CoV-2 antibody level of 50-1830 AU/mL) and responders (52 patients with an antibody level > 1830 AU/mL). We found that chronic heart failure (p < 0.00001), higher performance status (p = 0.004), hypoalbuminemia (p < 0.001), lymphopenia (p = 0.003), Rhesus status positivity (p = 0.02), and absence of response to a hepatitis B virus vaccine (p = 0.02) were associated with a poor response to a third dose of SARS-CoV-2 vaccine. In contrast, none of the dialysis-related variables were associated with the vaccine response. In multivariate logistic regression, chronic heart failure (p < 0.0001) and hypoalbuminemia (p = 0.0004) remained associated with a lower humoral response to SARS-CoV-2 vaccine.

CONCLUSIONS: Our results showed that chronic heart failure and hypoalbuminemia were factors associated with a poor humoral response after three doses of SARS-CoV-2 vaccine. However, we found no association between specific dialysis-related variables and the anti-SARS-CoV-2 antibody titer.

PMID:40551111 | PMC:PMC12186387 | DOI:10.1186/s12882-025-04264-3

Medicine (Baltimore). 2025 Jun 20;104(25):e43043. doi: 10.1097/MD.0000000000043043.

ABSTRACT

RATIONALE: Heart transplantation (HT) represents the optimal treatment for patients with end-stage heart disease. However, it is prone to numerous postoperative complications, among which cardio-renal syndrome (CRS) is particularly serious and carries a high mortality rate. Continuous renal replacement therapy is an essential supportive treatment for these patients, but its efficacy is highly dependent on precise nursing management. Currently, there are few reports on the care of CRS complicating HT both domestically and internationally. This case is presented in this report to provide reference for clinical work.

PATIENT CONCERNS: This report details the case of a 31-year-old man who underwent an in situ HT due to dilated cardiomyopathy with class IV cardiac function. Following the operation, he developed CRS, which led to oliguria, rapid deterioration of renal function, and cardiac failure.

DIAGNOSES: Cardiorenal syndrome, chronic kidney disease stage 4, post-dilated cardiomyopathy surgery, HT status, heart function class IV (NYHA classification).

INTERVENTIONS: This includes implementing a personalized continuous renal replacement therapy (CRRT) program and providing excellent CRRT care; closely monitoring for rejection and the side effects of immunosuppressants; and offering comprehensive psychological support.

OUTCOMES: After undergoing CRRT for 5 weeks, the patient's 24-hour urine volume, glomerular filtration rate, and N-terminal brain natriuretic peptide precursor levels stabilized, leading to discharge with improved renal function.

LESSONS: The key to a favorable renal function prognosis is the use of CRRT for precise volume management. Careful management of internal jugular vein catheterization is crucial for preventing infections in post-heart transplant patients. Additionally, monitoring the side effects of immunosuppressive drugs and signs of rejection are essential nursing points for patients with cardiorenal syndrome. Providing psychological care in various forms to patients and their families can help improve disease outcomes and ensure long-term efficacy after transplantation.

PMID:40550023 | PMC:PMC12187291 | DOI:10.1097/MD.0000000000043043

J Vis Exp. 2025 Jun 6;(220). doi: 10.3791/68090.

ABSTRACT

The number of advanced heart failure patients who can receive a heart transplant is limited by a shortage of suitable organ donors. In efforts to expand the donor pool, alternative donation and procurement methods have been developed, including heart transplantation following donation after circulatory death (DCD HT). While short-term survival following DCD HT is non-inferior to heart transplantation with brain-dead donors, there may be an increased rate of primary graft dysfunction (PGD) associated with DCD HT allografts. The underlying etiology of PGD is multifactorial and incompletely understood. For DCD HT allografts, the period of warm ischemic injury during DCD procurement is a potential risk factor for PGD to which brain death allografts are not exposed. The functional warm ischemic time thus may be an important driver of PGD in DCD HT. However, the mechanisms underlying PGD in this clinical scenario are poorly understood at the molecular level. The work presented herein aims to describe the development and validation of a high-fidelity non-survival porcine model of DCD orthotopic heart transplantation. We hypothesize that the use of this translational large animal model is critical to elucidate molecular mechanisms contributing to PGD, as well as to investigate interventions designed to optimize allograft preservation and early performance. This model replicates the perioperative and surgical approach used in DCD HT clinically, with modifications to account for porcine anatomy and physiology. The development of this large animal surgical model will not only provide mechanistic insights into the development of PGD but also can be modified to enhance translational research efforts aimed at improving organ recovery following DCD HT.

PMID:40549678 | DOI:10.3791/68090

Mol Biol Rep. 2025 Jun 23;52(1):623. doi: 10.1007/s11033-025-10729-3.

ABSTRACT

Recently, immunogene therapy has been of great interest in cardiovascular diseases. In this regard, various immune checkpoint inhibitors (ICIs) are identified to have a crucial role in regulating inflammatory responses. The T-cell immunoglobulin and mucin-domain containing molecule-3 (TIM-3, CD366), a relatively newly discovered group of molecules with a conserved structure, has emerged as a critical immune checkpoint with significant regulatory roles in cardiovascular inflammation and atherosclerosis. This prospective review explores the importance of TIM-3 in modulating immune responses relevant to ischemic heart diseases (IHD), highlighting its interactions with inflammatory pathways such as Toll-like receptor-4 (TLR-4). TIM-3, predominantly expressed on T cells, dendritic cells, and monocytes, acts as an inhibitory receptor that quenches pro-inflammatory signaling, particularly upon binding to ligands like galectin-9. Noteworthy, recent evidence suggests that TIM-3 deficiency or dysregulation can exacerbate inflammatory cascades, contributing to the progression of IHD and related complications. Here, the therapeutic potential of targeting TIM-3 for the management of IHD, especially in the settings of systemic inflammation and post-operative complications, has been discussed. By elucidating the molecular mechanisms and translational prospects of TIM-3 modulation, this work proposes new avenues for immunotherapeutic intervention in cardiovascular disease and post-operative SIRS, warranting further research in clinical trials.

PMID:40549173 | DOI:10.1007/s11033-025-10729-3

ASAIO J. 2025 Jun 23. doi: 10.1097/MAT.0000000000002487. Online ahead of print.

ABSTRACT

Although durable mechanical circulatory support (MCS) has been promising in supporting advanced heart failure patients, device hemocompatibility-related complications remain a major concern compared with heart transplantation. We investigated the blood damage potential of the three most recent clinically available, implantable MCS devices and compared their biocompatibility performance. One axial pump (HeartMate II) and two centrifugal pumps (HeartMate 3 and BrioVAD) were chosen for this study. In vitro experiments with healthy human blood and computational fluid dynamics simulations were performed to compare high-mechanical shear-induced blood trauma in these devices. Regions of higher shear stresses were identified. Power-law relations between shear stress and blood damage were implemented to assess hemolysis, platelet activation, and platelet receptor shedding of key functional receptors (glycoprotein [GP] Ibα, and GPVI) caused by these devices. HeartMate II caused the most severe blood trauma among these three devices, producing an order of magnitude larger values for hemolysis and platelet activation compared with HeartMate 3 and BrioVAD. Also, HeartMate II consistently exhibited the highest levels of receptor shedding, approximately double those caused by the HeartMate 3 and BrioVAD. The HeartMate 3 and BrioVAD centrifugal pumps showed similar performance in terms of blood damage.

PMID:40548579 | DOI:10.1097/MAT.0000000000002487

Exp Clin Transplant. 2025 May;23(5):317-327. doi: 10.6002/ect.2025.0089.

ABSTRACT

OBJECTIVES: Donation after circulatory death offers a promising solution to expand the thoracic organ donor pool, yet its application remains limited because of warm ischemia and technical barriers, especially in uncontrolled donation after circulatory death. We aimed to evaluate a pulsatile normothermic car-diopulmonary bypass-based strategy for thoracic organ recovery of uncontrolled donors after circulatory death and the effects of this strategy on graft function and recipient outcomes.

MATERIALS AND METHODS: In this prospective single-center study, we studied thoracic organs recovered from uncontrolled donors after circulatory death after ≥60 minutes of unsuccessful cardiopulmonary resuscitation. After heparinization and pharmacologic optimization, donors underwent median sternotomy and were connected to a cardiopulmonary bypass circuit with pulsatile flow. Organ assessment was performed in vivo. Donor, graft, and recipient functional data were recorded, with follow-up results studied through at least 1 year.

RESULTS: Forty-two donors were included. All hearts (n = 42) and 40 lungs (from 84 donors) were successfully transplanted. Despite prolonged cardiopulmonary resuscitation, no graft failure or recipient mortality occurred. One year survival for both heart and lung recipients was 100%. Heart grafts showed progressive improvement in functional status, including left ventricular ejection fraction, lactate levels, and New York Heart Association classification; lungs demonstrated sustained gains in gas exchange, pulmonary function tests, and 6-minute walk distance. Mild primary graft dysfunction (grade 1-2) occurred in 10% of lung recipients (all unilateral transplants). Pericardial effusion increased, likely because of trauma before procurement, but resolved without effects on function.

CONCLUSIONS: Pulsatile normothermic cardiopulmonary bypass enables successful procurement of thoracic organs from uncontrolled donors after circulatory death with excellent outcomes. This low-cost physiological approach may offer a viable strategy to expand availability of donors in resource-limited settings.

PMID:40548529 | DOI:10.6002/ect.2025.0089

Infect Control Hosp Epidemiol. 2025 Jun 23:1-8. doi: 10.1017/ice.2025.10217. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the mitigation strategies for a Candida auris outbreak in a cardiothoracic transplant intensive care unit (CTICU) and its implications for infection prevention practices.

DESIGN: Retrospective cohort study from July 2023 to February 2024.

SETTING: A large academic medical center.

METHODS: A multidisciplinary team convened to conduct the outbreak investigation and develop mitigation strategies in the CTICU.

RESULTS: From July 2023 to February 2024, 34 possible hospital-onset cases of C. auris were identified in our CTICU. Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two distinct outbreak clusters. Of the 34 patients, 11 (32.3%) were solid organ transplant recipients and 12 (35.3%) had a mechanical circulatory support device. Of the cohort, only 11/34 (32.3%) had prior exposure to high-risk healthcare facilities within six months prior to admission, as follows: acute inpatient rehabilitation facilities (AIRs) (n = 5, 14.7%), skilled nursing facilities (SNFs) (n = 3, 8.8%), and long-term acute care hospitals (LTACHs) (n = 3, 8.8%). The cohort had a median of 22.0 antibiotic-days prior to their positive results. Five (14.7%) patients had C. auris candidemia, three of whom expired likely due to infection. Infection Prevention (IP) interventions addressed several modes of transmission, including healthcare personnel hands, shared patient equipment, and the environment.

CONCLUSION: Our experience suggests that the epidemiology of C. auris may be changing, pointing towards a rising prevalence in acute care settings. IP interventions targeting hand hygiene behavior and promoting centralizing cleaning and disinfection of shared patient equipment may have contributed to outbreak resolution.

PMID:40548370 | DOI:10.1017/ice.2025.10217

Front Oncol. 2025 Jun 6;15:1570981. doi: 10.3389/fonc.2025.1570981. eCollection 2025.

ABSTRACT

BACKGROUND: POEMS syndrome is a rare multisystem disease secondary to plasma cell neoplasm. Due to its rarity, there are no internationally agreed treatment standards, with very limited data to guide management in the relapse setting.

CASE PRESENTATION: We describe a 51-year-old woman with initially presented with fatigue, anorexia, nausea, abdominal distension, and edema of the face and both lower limbs, who was diagnosed with POEMS syndrome accompanied with Raynaud's phenomenon and cardiac involvement. After multiple lines of treatment, including bortezomib, cyclophosphamide, and dexamethasone (VCD), ixazomib, and daratumumab along with dexamethasone (DD), her clinical and laboratory features, and cardiovascular system continued to deteriorate. Then we started carfilzomib and dexamethasone, and the patient achieved a complete response. She did not develop significant cardiac toxicity and peripheral neuropathy. A total of 4 cycles of carfilzomib and dexamethasone were administered monthly, followed by autologous stem cell transplantation (ASCT). After 4 months of follow-up, a complete remission persists, and no significant complications were observed.

CONCLUSION: We report on the first case of relapsed/refractory POEMS syndrome who received carfilzomib and dexamethasone, and achieved very good remission. Carfilzomib may be a safe and effective treatment option for patients with relapsed/refractory POEMS syndrome.

PMID:40548108 | PMC:PMC12179133 | DOI:10.3389/fonc.2025.1570981

Front Immunol. 2025 Jun 6;16:1538046. doi: 10.3389/fimmu.2025.1538046. eCollection 2025.

ABSTRACT

BACKGROUND: Chronic high-altitude hypobaric hypoxia leads to high-altitude heart disease and heart failure. Recent research has indicated that WJMSCs (Wharton's jelly-derived mesenchymal stem cells, WJMSCs) can alleviate ischemic myocardial injury and improve cardiac dysfunction, and macrophage polarization may have been involved. However, few studies have focused on the cardioprotective effects of WJMSCs against HAHI (high-altitude-induced heart injury, HAHI). Here, our research focused on how WJMSCs regulate macrophage polarization impacted myocardial repair in HAHI.

METHODS: C57/BL6J mice were fed for 28 days at a hypobaric chamber that had a comparable altitude of 6000 m, and WJMSCs were injected intravenously before HH (hypobaric hypoxia, HH) exposure. To assess cardiac function, echocardiography was carried out. Blood and heart tissue were collected for subsequent analysis. We simulated anoxic environment in vitro by inducing BMDMs (bone marrow-derived macrophages, BMDMs) with 1% O2, and employed co-culture system to investigate how WJMSCs affect macrophage polarization.

RESULTS: Abnormal myocardial fibrosis and cardiomyocyte apoptosis, cardiac inflammation and dysfunction were exhibited in the Chronic HAHI mouse model. WJMSCs infusion maintained the cardiac structure and function in HAHI mice. Furthermore, WJMSCs infusion was effective in elevating the M2 macrophages proportion and decreasing inflammation in the heart. In vitro studies revealed that hypoxia stimulation elevated the ratio of M1 macrophages in comparison to those in the Control group and coculturing with WJMSCs encouraged the shift of M1 to M2 macrophages. Surprisingly, the anti-inflammatory effects of WJMSCs on M2 polarization were negated with pretreatment of a COX2 (Cyclooxygenase-2, COX2) inhibitor, which could be reversed with PGE2 (prostaglandin E2, PGE2) addition.

CONCLUSIONS: In conclusions, our findings indicated that WJMSCs infusions may enhance M2 macrophage polarization through the COX2-PGE2 pathway, and therefore safeguard against cardiac damage in HAHI mice.

PMID:40547034 | PMC:PMC12180414 | DOI:10.3389/fimmu.2025.1538046

Front Immunol. 2025 Jun 6;16:1532325. doi: 10.3389/fimmu.2025.1532325. eCollection 2025.

ABSTRACT

BACKGROUND: Epitranscriptomics, with m6A as the most prevalent in mammals, is a novel treatment target for inflammatory diseases, including cardiovascular diseases. However, little is known about m6A RNA-regulation during myocardial infarction (MI).

METHODS: In this explorative sub-study of the ASSAIL-MI trial, we used whole blood samples from patients with acute ST-elevation MI (STEMI) (n=6) at admission and after 3-7 days, and from healthy control subjects (n=3). RNA was isolated, and m6A sites were analyzed using human m6A single nucleotide resolution microarray analysis. mRNA levels were analyzed using RNA sequencing analysis.

RESULTS: Compared with controls, patients with STEMI had a strikingly different pattern of m6A deposition. In total, 845 m6A methylation sites in whole blood RNA were hypomethylated and 36 were hypermethylated compared with controls. Of the hypomethylated transcripts, 194 transcripts were lower expressed, while 197 transcripts were higher expressed. The m6A pattern changed from an overall hypomethylation at admission to an overall hypermethylation 3-7 day after admission. Anti-inflammatory treatment with tocilizumab further altered the m6A deposition.

CONCLUSIONS: In this hypothesis generating study, m6A deposition differs STEMI patients and healthy controls. The m6A pattern changes over the course of 3-7 days. This response is, at least to some degree, is modulated by blocking the IL-6 receptor. Our data may suggest that this post-transcriptional regulation of RNA is involved in the immune response during STEMI, highlighting its potential as a target for therapy in MI.

PMID:40547027 | PMC:PMC12178860 | DOI:10.3389/fimmu.2025.1532325

Cureus. 2025 May 23;17(5):e84680. doi: 10.7759/cureus.84680. eCollection 2025 May.

ABSTRACT

Burkitt lymphoma (BL) is a highly aggressive B-cell non-Hodgkin lymphoma (NHL) that rarely occurs as a post-transplant lymphoproliferative disorder (PTLD), especially in the elderly. We report a rare case of BL in a male in his 70s who developed BL several years following heart transplantation in the setting of chronic immunosuppression. He initially presented with signs and symptoms of severe hypercalcemia and retroperitoneal lymphadenopathy, which was biopsied to confirm the diagnosis. Treatment was initiated with rituximab and intrathecal methotrexate; however, his hospital course was complicated by a sigmoid microperforation due to a newly formed colonic fistula. This is an unusual case of Epstein-Barr virus (EBV) reactivation causing PTLD and underscores the importance of considering aggressive lymphomas in immunocompromised elderly patients following solid organ transplantation.

PMID:40546500 | PMC:PMC12182806 | DOI:10.7759/cureus.84680

Oral Dis. 2025 Jun 22. doi: 10.1111/odi.70012. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney transplant recipients (KTRs) experience immune modulation, which may lead to graft rejection and other adverse outcomes. Although serum cytokines are well-established systemic immune markers, the role of salivary biomarkers has never been reported in the literature.

OBJECTIVE: To investigate salivary and serum cytokine levels in KTRs and their correlations with clinical outcomes over time.

MATERIALS AND METHODS: We evaluated the same group of 38 KTRs at T1 (< 6 months post-transplantation) and T2 (> 6 months post-transplantation). Samples were analysed with Human 6-Plex Cytokine Panel (Luminex) and clinical data were collected from medical records. Statistical analyses included Wilcoxon tests, Fisher's exact tests, Spearman's correlation, and Benjamini-Hochberg procedure for multiple comparisons (p < 0.05 significant).

RESULTS: Serum cytokines showed lower IFN-γ levels in cardiac events and associations of TNF-α, IL-8, and IL-10 with cytomegalovirus (CMV), BK polyomavirus (BKPyV) viremia and anaemia. Salivary cytokines showed distinct profiles, with elevated levels of TNF-α in anaemia and IL-8 in patients with diarrhoea. Those not experiencing acute rejection in both cases showed reduced salivary IL-8 levels.

CONCLUSIONS: Integrating serum and salivary measurements highlighted the potential of salivary biomarkers, particularly TNF-α and IL-8, in complementing traditional blood-based assays and other invasive monitoring methods in kidney transplantation.

PMID:40545713 | DOI:10.1111/odi.70012

Catheter Cardiovasc Interv. 2025 Jun 22. doi: 10.1002/ccd.31698. Online ahead of print.

ABSTRACT

Cardiogenic shock (CS) remains a high morbidity and mortality condition worldwide frequently complicating acute myocardial infarction (AMI) and decompensated heart failure (HF). Within the management of CS, mechanical circulatory support (MCS) devices play a critical role in maintaining hemodynamic stability, preserving end-organ perfusion and bridging patients through to recovery, implantation of durable support or transplantation. Despite their use, optimal timing of initiation, as well as patient and device selection remain unclear. This review explores the current landscape of MCS devices, surrounding evidence and key distinctions between devices. With increasing acknowledgment for the heterogeneity of CS, understanding the strengths and limitations of each device remains crucial to improving outcomes in this high-risk population.

PMID:40545708 | DOI:10.1002/ccd.31698

Transplantation. 2025 Jun 23. doi: 10.1097/TP.0000000000005377. Online ahead of print.

ABSTRACT

BACKGROUND: There is a growing population of solid organ transplant (SOT) survivors who subsequently require a hematopoietic cell transplant (HCT), although there are limited data on survival, risk factors for SOT graft loss, and death in this cohort.

METHODS: This retrospective Center for International Blood and Marrow Transplant Research study included recipients of SOT followed by HCT between 1989 and 2017. HCT data were merged with organ transplant data from the Organ Procurement and Transplantation Network.

RESULTS: Eighty-three patients with an SOT underwent an HCT. Organs transplanted included heart/lung (thoracic, n = 15), kidney (n = 42), and liver (n = 26); 24 patients (29%) received a living donor graft and 59 (71%) a deceased graft. Forty-one patients (49.4%) received an allogeneic HCT and 42 (50.6%) an autologous HCT. Three-year overall survival (OS) from HCT in the entire cohort was 38.6%. There were no significant differences in OS by SOT type, although 3-y OS appeared lowest in the kidney SOT group at 29.9%, compared with liver SOT at 40.6% and thoracic SOT at 58.2%. The incidence of SOT graft failure 3 y post-HCT was 59.1%. There were no significant differences in SOT graft failure by organ type: 3-y failure probability 67.2% for kidney, 56.5% for liver, and 46.2% for thoracic. Shared risk factors for death and graft failure included HCT indication (leukemia, lymphoma, and nonmalignant diseases), HCT type (allogeneic), and SOT type (kidney).

CONCLUSIONS: Although some SOT recipients may benefit from HCT, the incidence of SOT graft failure was high and OS was poor, particularly after allogeneic HCT.

PMID:40545567 | DOI:10.1097/TP.0000000000005377

Int J Cardiol. 2025 Jun 20:133521. doi: 10.1016/j.ijcard.2025.133521. Online ahead of print.

NO ABSTRACT

PMID:40544878 | DOI:10.1016/j.ijcard.2025.133521

Cardiorenal Med. 2025 Jun 20:1-25. doi: 10.1159/000546924. Online ahead of print.

ABSTRACT

BACKGROUND: Heart failure (HF) prevalence is increasing, and its prognosis worsens in the presence of other comorbidities. Up to 70% of patients develop cardio-renal syndrome (CRS), which is associated with diuretic resistance or kidney deterioration over time. Peritoneal dialysis (PD) for ultrafiltration (PD-UF) could be a potential therapeutic option in CRS, although its long-term outcomes have not been described.

METHODS: Retrospective registry study of the Catalan Renal Registry on patients with PD-UF indication between 2013-2022. Baseline clinical characteristics and follow-up until December/2022 was studied.

RESULTS: Of the 1874 incident patients on PD,198(10.6%) were PD-UF,73.2% of the patients were male and the mean age was70.7±9.3 years. Median eGFR at start was 22.6 [IQR14.8-32.8] ml/min·1.73m2 and 75.0% have an eGFR above 15 ml/min·1.73m2. Previous history of ischemic heart disease, arrhythmia or cardiac surgery was recorded, 57.6% of patients had ≥2 of these pathologies. The most common HF etiology was ischemic heart disease in 21.7% of patients. Median overall patient survival was 21 months [IQR17.3-24.3]. Technique survival at one year was 94.8%, and 27 patients were transferred to other renal replacement therapy (hemodialysis or kidney transplantation). In the cox multivariate analysis, age>75 years (HR 1.76[95%CI 1.20-2.59]), mild frailty (HR2.18[95%CI 1.17-2.59]), severe frailty (HR 17.62[95%CI 1.20-55.48]) and the burden of cardiac disease (2 categories HR 2.17[95%CI 1.05-4.47]; 3 categories HR 2.26 [95%CI 1.05-4.89]) were associated with poor overall survival. Technique survival was associated with eGFR (<30 ml/min·1.73m2 HR 5.64[95%CI 1.32-24.18]) and body mass index (<20 kg/m2 HR 6.53 [95%CI 1.06-40.12]) at baseline.

CONCLUSION: PD-HF is a feasible option in patients with advanced HF and CRS. The complexity of this population increases with older age, frailty and higher cardiac burden.

PMID:40544832 | DOI:10.1159/000546924