Trasplante cardíaco

Curr Opin Nephrol Hypertens. 2025 Sep 25. doi: 10.1097/MNH.0000000000001114. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Postoperative acute kidney injury (PO-AKI) is a common complication associated with increased morbidity and mortality. Despite its frequency, guidelines for the prevention of PO-AKI are relatively recent and still based on weak or contradictory evidence. This review aims to summarize large recent studies published in the past 2 years that have attempted to address these gaps.

RECENT FINDINGS: While the POST-CABGDM and Stop-or-Not trials have provided additional evidence on the preoperative prescription of RAAS and SGLT2 inhibitors in selected surgical settings, future research must integrate preoperative risk profiling to personalize therapy. Likewise, although the POISE-3 trial seems to suggest that maintaining a mean arterial pressure of at least 60 mmHg is crucial in noncardiac surgery, it does not explore how targets might be personalized. In cardiac surgery, both the SIRAKI02 trial (i.e., extracorporeal blood purification membrane connected to the cardiopulmonary bypass) and the PROTECTION trial (i.e., intraoperative amino-acid infusion) demonstrated benefit only for mild AKI, raising questions about their mechanistic basis and clinical significance.

SUMMARY: "Prevention is better than cure," a principle that holds particularly true for PO-AKI, a common complication that still lacks effective curative treatments. Although the recent abovementioned trials have yielded important findings, they concurrently underscore the significant obstacles in conducting clinical trials on PO-AKI and in formulating robust recommendations based on their outcomes.

PMID:40990657 | DOI:10.1097/MNH.0000000000001114

Kardiol Pol. 2025 Sep 24. doi: 10.33963/v.phj.108672. Online ahead of print.

NO ABSTRACT

PMID:40990557 | DOI:10.33963/v.phj.108672

Clin Kidney J. 2025 Jul 12;18(8):sfaf222. doi: 10.1093/ckj/sfaf222. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: Emerging evidence suggests that ambient air pollution may adversely affect long-term outcomes in kidney transplant recipients; however, quantitative estimates across clinical endpoints remain limited. This meta-analysis aimed to systematically evaluate the association between air pollution exposure and mortality, graft failure, and rejection risk in kidney transplant populations.

METHODS: A systematic database search was carried out across the databases of the Cochrane Library, Web of Science, Scopus, and PubMed until the 1 May 2025. Research that evaluated the impact of air pollution, particularly PM₂.₅, PM₁₀, NO₂, O₃, and other ambient pollutants, on graft survival in kidney transplant recipients were evaluated. Hazard ratios (HR) were extracted or recalculated for all-cause mortality, death-censored graft failure, and graft rejection per 10 µg/m³ increase in particulate matter concentration.

RESULTS: After screening 6209 records, a total of six studies involving populations of adult kidney transplant recipients from the USA, UK, South Korea, and Taiwan were included in the meta-analysis. Exposure to ambient air pollution was significantly associated with increased all-cause mortality among kidney transplant recipients [pooled HR 1.61; 95% confidence intervals (CI) 1.01-2.58], as well as higher risks of death-censored graft failure (HR 1.25; 95% CI 1.04-1.50) and graft rejection (HR 1.35; 95% CI 1.09-1.69) per 10 µg/m³ increment in particulate matter concentration. Substantial heterogeneity was observed across studies, particularly for mortality (I² = 99%) and graft rejection (I² = 91%). No significant associations were found between air pollution exposure and cardiovascular disease or coronary heart disease mortality.

CONCLUSION: Ambient air pollution exposure is associated with increased risks of mortality, graft failure, and rejection in kidney transplant recipients, highlighting air pollution as a modifiable environmental risk factor that may have important implications for long-term transplant outcomes.

PMID:40989710 | PMC:PMC12451696 | DOI:10.1093/ckj/sfaf222

Circ Heart Fail. 2025 Sep 24:e012592. doi: 10.1161/CIRCHEARTFAILURE.124.012592. Online ahead of print.

ABSTRACT

BACKGROUND: Dilated cardiomyopathy (DCM) is a genetically heterogeneous disease, presenting diverse clinical phenotypes and outcomes based on the underlying gene affected. The influence of sex on the gene-specific long-term prognosis of patients with genetic DCM remains unclear. This study aims to determine the effect of sex on the long-term prognosis per underlying genogroup.

METHODS: A retrospective cohort study was conducted using data from 4 international referral centers. Baseline and longitudinal clinical data of patients with DCM, with a median follow-up of 6.7 years (interquartile range, 3.5-11.9 years), were collected. The study included men and women with DCM who had undergone genetic testing. Patients were categorized into 7 genotype groups: cytoskeletal/Z-disk, desmosomal, nuclear envelope, motor sarcomeric, TTN, other genetic, and genotype negative. The main outcomes measured were left ventricular reverse remodeling, mortality, heart failure hospitalization, heart transplantation, and malignant ventricular arrhythmias.

RESULTS: Among 1716 patients, 1130 (66%) were men and 510 (30%) had a (likely) pathogenic variant. Ventricular remodeling was gene-dependent in women, with TTN patients exhibiting the highest rate (P=0.003) and desmosomal patients the lowest (P=0.04) compared with the genotype-negative group. After a median follow-up of 6.7 years, 334 men (29%) and 140 women (24%) reached the primary end point. Men with a (likely) pathogenic variant had the poorest prognosis, showing a higher rate of major adverse events (adjusted hazard ratio, 1.48 [95% CI, 1.12-1.95]; P=0.02) and malignant ventricular arrhythmias (adjusted hazard ratio, 1.83 [95% CI, 1.16-2.88]; P=0.009) compared with genotype-negative women. Prognosis varied by gene in men (log-rank P<0.0001) but not in women (log-rank P=0.1). The cytoskeletal/Z-disk, desmosomal, and nuclear envelope groups had the worst prognosis in men.

CONCLUSIONS: The genetic architecture and sex are critical predictors of left ventricular reverse remodeling and long-term prognosis in DCM. These factors should be integrated into individualized risk prediction models to enhance clinical outcomes in patients with DCM.

PMID:40988625 | DOI:10.1161/CIRCHEARTFAILURE.124.012592

Hum Immunol. 2025 Sep 22;86(6):111587. doi: 10.1016/j.humimm.2025.111587. Online ahead of print.

ABSTRACT

Studies have demonstrated that the liver acts as an immunologic sink when transplanted with another organ from the same donor. In this work, we review evidence of this phenomenon in kidney-liver and heart-liver transplantation. We then explore the pros and cons of this strategy as a way of helping to transplant end stage heart failure patients who are highly allosensitized but do not have severe liver disease. By considering this strategy in the context of alternative therapies, we explain the types of patients who may benefit from it.

PMID:40987086 | DOI:10.1016/j.humimm.2025.111587

Hepatology. 2025 Sep 23. doi: 10.1097/HEP.0000000000001524. Online ahead of print.

ABSTRACT

BACKGROUND AIMS: Point-of-care ultrasound(POCUS) helps in assessing volume status and cirrhotic cardiomyopathy(CCM). We evaluated POCUS-guided volume management and explored clinical predictors, including CCM, of acute kidney injury(AKI) reversal and need for renal replacement therapy(RRT), and survival, in cirrhosis and AKI between January 2023 and November 2024. Exclusions were patients with structural cardiac disease, portopulmonary hypertension, acute variceal bleeding, and septic shock.

METHODS: POCUS was performed at ICU admission(Timezero), 24h,48h,72h, and as needed to guide volume management, and determine inferior vena cava(IVC) indices and cardiac index. CCM was defined by ≥3 of 4 variables(septal e' velocity, E/e' integral, left atrial volume index, tricuspid regurgitant velocity); clinical data were collected.

RESULTS: 372 patients with AKI [84.7% men, aged 50.3±12 years, MELD-Na 23.9±5.1]; 296(79.6%), 42(11.3%), and 34(9.1%) were classified as hypovolemic, euvolemic, and hypervolemic at Timezero. Following POCUS-guided volume management, 231(62%) had pre-renal AKI; 61(16.4%) hepatorenal syndrome(HRS-AKI); 25(6.7%) HRS-AKD; 32(8.6%) HRS-CKD, while 23(6.2%) had a multifactorial etiology. CCM was diagnosed in 34.7%; 32.9% of pre-renal AKI, 75.4% in HRS-AKI, and 28% in HRS-AKD(p<0.001). Higher MAP0h (aHR1.9, 95%CI:1.96-2, p=0.039) and cardiac index0h(aHR1.2,95%CI:1.1-1.3,p=0.005) predicted AKI reversal at Day-7;53/372(14.2%) underwent RRT. Pulmonary edema developed in 4.8% overall; in 5.4% with CCM. Overall mortality was 46(12.4%) and 107(28.8%) at 90-days and 1-year. CCM predicted mortality at 90-days(aHR 8.9,95%CI:3.9-20.4,p<0.001) and one year(aHR1.7,95%CI:1.2-2.5,p=0.007). Cardiac index (aHR0.6,95%CI:0.4-0.9,p=0.005), and septal e' velocity(aHR 0.5,95% CI:0.3-0.7,p=0.010) predicted need for RRT.

CONCLUSIONS: POCUS facilitates volume management and AKI reversal in cirrhosis. CCM predicts poor outcomes in HRS-AKI, need for RRT, and mortality.

PMID:40986890 | DOI:10.1097/HEP.0000000000001524

Transplantation. 2025 Sep 23. doi: 10.1097/TP.0000000000005503. Online ahead of print.

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter inhibitors (SGLTi) slow chronic kidney disease progression and reduce kidney failure events. Kidney transplant recipients (KTRs) remain at high risk for these outcomes. SGLTi cause an initial and sustained decline in estimated glomerular filtration rate (eGFR) and have a higher risk of urogenital infection, both of which are major concerns for KTRs. We sought to (1) assess the reversibility of eGFR changes and (2) explore safety and tolerability using sotagliflozin, a dual SGLT1/2 inhibitor.

METHODS: We enrolled stable KTRs in a 16-wk open-label trial of sotagliflozin (12 wk on-drug and 4 wk off-drug) to assess the reversibility of eGFR changes. We assessed whether patient awareness of eGFR changes altered rates of withdrawal by randomizing participants to either (1) unlimited access to all study-related eGFR measurements or (2) limited access, that is, only when eGFR declined to >25% from baseline.

RESULTS: Forty patients were randomized. The mean age was 56 ± 15 y; the mean baseline eGFR was 64 ± 21 mL/min/1.73 m2. After 1 wk, change in eGFR from baseline was -4.6 ± 6.5 mL/min/1.73 m2 (-6.9 ± 9.5%). After washout, eGFR improved to -2.0 ± 6.3 mL/min/1.73 m2 (-2.4 ± 11%), with 73% of patients within 10% of baseline eGFR or higher. Limited versus unlimited access to eGFR measurements did not affect protocol completion (P = 0.34). Sotagliflozin was generally well tolerated, but 4 patients were withdrawn due to adverse events, with none due to decline in eGFR.

CONCLUSIONS: Among stable KTRs, sotagliflozin caused an initial decline in eGFR of similar magnitude to patients with chronic kidney disease, with reversibility upon withdrawal. Access to follow-up eGFR measurements did not affect study adherence.

PMID:40986618 | DOI:10.1097/TP.0000000000005503

Eur J Cardiothorac Surg. 2025 Sep 23:ezaf318. doi: 10.1093/ejcts/ezaf318. Online ahead of print.

ABSTRACT

OBJECTIVES: Bilateral transverse thoracosternotomy ('clamshell') is widely used for (heart-)lung transplantations but postoperative sternal complications are a significant challenge. The primary objective of this systematic review was to evaluate the prevalence of sternal complications after clamshell surgery in (heart-)lung transplantation patients.

METHODS: A systematic literature review was conducted. On April 4, 2025, PubMed and Embase databases were searched. Original studies reporting sternal complications after clamshell surgery in adults for bilateral lung or heart-lung transplantation were included. Studies including <10 patients were excluded. Study quality was assessed using the National Institutes of Health assessment tool. The total and range of sternal complication prevalence was provided. Meta-analysis of sternal complication prevalence was not performed due to significant heterogeneity across studies.

RESULTS: The database searches yielded 945 eligible articles. 18 studies were included, including 828 patients who underwent a total of 830 bilateral lung or heart-lung transplantations through clamshell surgery. All included studies were cohort studies with poor (n = 15), fair (n = 1), or good (n = 2) quality. In total, 286 sternal complications were reported (0.34 event per clamshell surgery; range 0.02 to 1.35 in individual studies) and 90 sternal reoperations were conducted (0.14 reoperation per clamshell surgery; range 0.02 to 0.29 in individual studies).

CONCLUSIONS: Despite limitations in study quality and heterogeneity, this review highlights the high prevalence and relevance of sternal complications following clamshell surgery for (heart-)lung transplantation. Future studies should focus on patient selection, risk stratification, development of modified sternal closure techniques, and implementation of alternative surgical approaches to (heart-)lung transplantation.

PMID:40986383 | DOI:10.1093/ejcts/ezaf318

Nutr Clin Pract. 2025 Sep 23. doi: 10.1002/ncp.70037. Online ahead of print.

ABSTRACT

BACKGROUND: Our objective was to characterize enteral nutrition safety practices and education for pediatric solid organ transplant recipients and compare practices with the 2017 American Society for Parenteral and Enteral Nutrition (ASPEN) Safe Practices for Enteral Nutrition Therapy.

METHODS: A 43-question electronic survey was distributed through the national registered dietitian pediatric transplant listserv. Questions reviewed formula hang-time, preparation, storage during initial transplant admission, and discharge education.

RESULTS: Sixty-six of 216 (31%) individuals completed at least one survey section. Forty-one of 47 (87%) reported a standard inpatient policy, and 40/40 (100%) reported ASPEN Safe Practices compliance for nonsterile powder formula with or without additives or unfortified and fortified human milk, whereas 33/39 (85%) complied for sterile liquid formula in an open system. Hospital size, type, and location did not predict compliance practices. Discharge education was primarily provided by dietitians (98%) and nurses (37%). Four-hour hang-time education was provided by 18/42 (43%) respondents for sterile formula in an open system, 31/42 (74%) for nonsterile powder formula in an open system, and 35/42 (83%) for nonsterile formula with additives. Educator type (dietitian vs non-dietitian or nurse vs non-nurse) did not predict compliance for sterile liquid in open system or nonsterile powder formula in an open system.

CONCLUSION: Inpatient policies for formula hang-time are highly compliant with 2017 ASPEN recommendations. However, formula hang-time discharge education varied, particularly for sterile liquid formula in an open system. Standardizing enteral nutrition safety education for transplant patients is critical for minimizing infection risk within this immunocompromised population.

PMID:40985927 | DOI:10.1002/ncp.70037

Eur J Cardiothorac Surg. 2025 Sep 23:ezaf315. doi: 10.1093/ejcts/ezaf315. Online ahead of print.

ABSTRACT

OBJECTIVES: Donation after circulatory-determined death (DCD) heart transplantation has increased the number of hearts available for transplantation by 30-40%. This may be associated with improved clinical outcomes for patients waiting for transplantation. We compare clinical outcomes from registration on the transplant waiting list before and after establishment of a DCD heart transplant program.

METHODS: Observational cohort study of all patients listed for heart transplantation at a single centre for three years before (cohort one) and three years after (cohort two) the start of a DCD heart transplant program. Outcome measures included heart transplantation, removal from waiting list due to death or deterioration, removal from waiting list due to improvement or patient choice, and need for mechanical circulatory support after listing for heart transplantation.

RESULTS: 129 patients were registered on the waiting list in cohort one and 146 patients in cohort two. Patients in cohort one underwent 91 DBD and 12 DCD heart transplants. Patients in cohort two underwent 102 DBD and 32 DBD heart transplants. Compared with cohort one, patients in cohort two had a shorter waiting time for transplantation (45 vs 77 days, P = 0.001) and an increased cumulative incidence of transplantation (P < 0.001). When all patients had reached an end-point, patients in cohort two had a lower likelihood of death or removal from waiting list due to deterioration (6% vs 18%, P = 0.011) and fewer patients in cohort two required mechanical circulatory support after listing (4.1% vs 13.9%, P = 0.007).

CONCLUSIONS: In a single centre, introduction of a DCD heart transplant program was associated with shorter waiting times for heart transplantation and a lower likelihood of death/deterioration or requirement for mechanical circulatory support whilst waiting for heart transplantation.

PMID:40985735 | DOI:10.1093/ejcts/ezaf315

J Cardiovasc Surg (Torino). 2025 Aug;66(4):308-315. doi: 10.23736/S0021-9509.25.13252-7.

ABSTRACT

BACKGROUND: The aim of this study was to compare the postoperative morbidity and mortality between total replacement of the aortic arch using the frozen elephant trunk technique versus replacement of the hemiarch in patients with acute type A aortic dissection and dissection of arch branch vessels without cerebral malperfusion.

METHODS: Between January 2015 and April 2023, 156 patients with acute type A aortic dissections were treated in our Center. Only patients with TAE2M2- (Type A or Type non-A non-B, with entry tear in arch aorta extend to arch branch vessels dissection without symptoms) were included. Patients were analyzed according to the surgical techniques: FET or hemiarch replacement.

RESULTS: Forty-two patients were included in our study. In hospital mortality was similar between the groups (FET: 12%, Hemiarch: 0%; P=0.2593). Survival at 5 years was 88% in the FET group and 94.1% in the hemiarch group (P=0.5243). Patients treated with FET showed a higher incidence of additional procedures on the remaining aorta (36.4% versus 0%, P=0.0056). Stroke with permanent neurologic dysfunction were similar between the groups (FET 8% and Hemiarch 11.8%; P=1.0000).

CONCLUSIONS: FET and hemiarch replacement showed similar short- and mid-term results. The FET technique offers advantages for distal aorta protection and future endovascular interventions but is associated with longer circulatory arrest and higher transfusion requirements. No significant survival or neurological benefits were observed for FET over ODA in the absence of malperfusion.

PMID:40985630 | DOI:10.23736/S0021-9509.25.13252-7

J Eur Acad Dermatol Venereol. 2025 Sep 23. doi: 10.1111/jdv.70067. Online ahead of print.

ABSTRACT

BACKGROUND: Alopecia areata (AA) is an autoimmune condition leading to hair loss. Baricitinib, a Janus kinase (JAK) inhibitor, has demonstrated efficacy in controlled clinical trials, but real-world data on its long-term effectiveness and safety remain limited.

OBJECTIVES: This study aimed to assess the real-life effectiveness and safety of baricitinib 4 mg daily in Italian adult patients with severe AA over a 48-week treatment period.

METHODS: We conducted a 48-week retrospective, observational, multicenter study across 27 Italian university hospitals. Adult patients (18-65 years) with severe AA (Severity of Alopecia Tool [SALT] score ≥ 50) who initiated baricitinib 4 mg daily treatment between November 2022 and October 2023 were included. Effectiveness was measured by the percentage of patients achieving SALT ≤20 at week 48. Secondary outcomes included changes in mean SALT score, trichoscopic findings, patient-reported quality of life (Skindex-16, Hospital Anxiety and Depression Scale [HADS]), and Clinician-Reported Outcomes (ClinRO) for eyebrows and eyelashes. Adverse events were also documented.

RESULTS: A total of 253 patients (66.8% females, mean age 40.0 ± 12.6 years) were included. By week 48, 63.2% achieved SALT ≤20, and 75.5% achieved SALT ≤30. The mean SALT score significantly decreased from 93.7 ± 14.1 at baseline to 26.5 ± 33.0 at week 48 (p < 0.001). Trichoscopic assessment showed a decline in yellow dots (97.6%-50.2%), black dots (43.5%-9.1%), and dystrophic hairs (14.6%-4.3%), whilst regrowing hairs increased (7.1%-80.2%). Skindex-16 scores improved significantly (57.1 ± 25.0 to 30.0 ± 17.8, p < 0.001), as did HADS Anxiety (8.21 ± 9.38 to 4.62 ± 4.21, p < 0.001) and HADS Depression (6.36 ± 4.55 to 3.70 ± 4.11, p < 0.001). Adverse events were reported in 9.4% of patients.

CONCLUSION: This real-world study confirms the effectiveness of baricitinib in achieving significant hair regrowth and improving psychological well-being in severe AA patients.

PMID:40985491 | DOI:10.1111/jdv.70067

Eur Heart J Cardiovasc Imaging. 2025 Sep 23:jeaf281. doi: 10.1093/ehjci/jeaf281. Online ahead of print.

NO ABSTRACT

PMID:40985273 | DOI:10.1093/ehjci/jeaf281

CNS Neurosci Ther. 2025 Sep;31(9):e70621. doi: 10.1111/cns.70621.

ABSTRACT

AIM: To investigate whether genetically modifying human umbilical cord-derived mesenchymal stem cells (MSC) to overexpress the CXCR4 receptor can enhance their therapeutic efficacy for treating brain injury following cardiac arrest (CA).

METHODS: MSC were engineered to overexpress CXCR4 (CXCR4-MSC) via lentiviral transduction. The migration capacity of these cells was tested using in vitro chemotaxis assays. In a rat model of CA/CPR, the homing ability of CXCR4-MSC to the brain was tracked in vivo, and their therapeutic effects on neuronal death and neurological recovery were assessed. The role of exosomes and their impact on key proteins (NLRP3, ASC, GSDMD) in the pyroptosis pathway was also investigated.

RESULT: CXCR4 overexpression significantly enhanced the migration of MSC in vitro and their homing to injured brain tissue in vivo. Treatment with CXCR4-MSC markedly reduced neuronal death and improved neurological recovery in resuscitated rats. This was accompanied by decreased expression of NLRP3. Furthermore, exosomes derived from CXCR4-MSC were found to suppress pyroptosis-related proteins (NLRP3/ASC/GSDMD) in post-CPR neurons, an effect that was reversed upon exosome inhibition.

CONCLUSION: Genetic modification to overexpress CXCR4 enhances the therapeutic efficacy of MSC for CA-induced brain injury by promoting their migration to the brain via the CXCL12/CXCR4 axis. A key mechanism of this protection is exosome-mediated inhibition of neuronal pyroptosis.

PMID:40984643 | PMC:PMC12454672 | DOI:10.1111/cns.70621

Ann Transplant. 2025 Sep 23;30:e949664. doi: 10.12659/AOT.949664.

ABSTRACT

BACKGROUND Patients with chronic kidney disease (CKD) have a markedly increased cardiovascular risk, largely due to persistent endothelial dysfunction (ED). Kidney transplantation improves cardiovascular status, but whether transplant type-living donor (LDT) or cadaver donor transplantation (CDT)-differentially affects coronary endothelial function remains unclear. MATERIAL AND METHODS In this prospective observational study, 75 kidney transplant recipients (LDT: n=50; CDT: n=25) and 25 healthy controls (HC) underwent CFVR measurement at baseline (CFVR-1) and 6 months post-transplantation (CFVR-2). Left ventricular ejection fraction (LV-EF), diameters, and NT-proBNP were also assessed. Group comparisons and pre-/post-transplant changes were analyzed. RESULTS Baseline CFVR was higher in HC than in transplant groups (p0.05), but CFVR-1 0.05). A ≥10% EF increase occurred in 36% of patients in each group. CONCLUSIONS Kidney transplantation improves coronary endothelial function and cardiac performance regardless of donor type, though severe baseline CFVR impairment is more common in cadaveric recipients.

PMID:40984640 | DOI:10.12659/AOT.949664

BMC Cardiovasc Disord. 2025 Sep 22;25(1):654. doi: 10.1186/s12872-025-05147-z.

ABSTRACT

BACKGROUND: Obesity is a common risk factor for heart failure, and heart transplantation (HTx) is the treatment of choice for end-stage heart failure. Due to the limited availability of the donor's heart, efforts are made to increase the donor pool on one hand and to find predictors that can impact HTx outcomes on the other hand. These predictors can help improve donor organ allocation and HTx outcomes. This study aims to investigate the impact of the donor-recipient BMI ratio on follow-up mortality and other outcomes after HTx.

METHODS: From 2012 to 2021, 821 patients underwent HTx in our centre. Patients under 18 years, re-transplantation, multiorgan transplantation, and missing recipient and donor BMI data were excluded. The final sample size of 653 patients was divided into three quartile categories based on the donor-recipient (D-R) BMI ratio. D-R BMI ratio < 0.86 (n = 156), D-R BMI ratio 0.86-1.12 (n = 338), and D-R BMI ratio > 1.12 (n = 159). Analysis of variance and chi-square test with post hoc test according to the types of variables were performed to find differences among the groups. Kaplan-Meier survival analysis was used to evaluate survival, and the difference between the curves was checked with the log-rank test. Cox regression analysis was used to adjust for confounders and find independent predictors of mortality.

RESULTS: Some preoperative variables were statistically different between the groups. The D-R BMI ratio did not impact follow-up mortality after adjustment for confounders. The 7-year survival in D-R BMI ratios < 0.86, 0.86-1.12, and > 1.12 was 73%, 68%, and 70% respectively (p = 0.532). There was no significant difference in other postoperative outcomes, including ICU stay, systemic complications, and mechanical circulatory support use, between the groups based on unadjusted analysis.

CONCLUSION: The donor-recipient BMI ratio had no significant impact on post-transplantation mortality. Postoperative outcomes other than survival were also comparable between the groups. These outcomes were observed in a specific D-R BMI ratio range (0.77-1.26), and extreme BMI ratios may have different results. The results of this study support the liberal use of donor and recipient BMI during patient matching, which can decrease the likelihood of potential donor non-use and subsequently increase the donor pool.

PMID:40983895 | PMC:PMC12452006 | DOI:10.1186/s12872-025-05147-z

J Cardiol. 2025 Sep 20:S0914-5087(25)00242-4. doi: 10.1016/j.jjcc.2025.09.012. Online ahead of print.

ABSTRACT

BACKGROUND: While vitamin K antagonist (VKA) has traditionally been the preferred treatment for left ventricle (LV) thrombus, the comparative efficacy and safety of direct oral anticoagulants (DOACs) with VKA in this setting remain unelucidated.

METHODS: A comprehensive literature search of PubMed and Google Scholar was conducted through May 7, 2025, to identify randomized controlled trials (RCTs) comparing DOACs with VKA in patients with LV thrombus. The primary endpoint was complete resolution of LV thrombus. Secondary endpoints included stroke, systemic embolism, the composite of both stroke and systemic embolism, major bleeding, and all-cause mortality. Both pairwise and network meta-analyses were performed using a random-effects model to synthesize the effect estimates.

RESULTS: Eight RCTs comprising a total of 576 patients were included. Collectively, 88.9 % of the patients treated with DOACs and 81.7 % of those receiving VKA experienced LV thrombus resolution, with a synthesized risk ratio (RR) of 1.01 [95 % confidence interval (CI), 0.94 to 1.07]. No significant differences were observed between the two groups for stroke (RR, 0.75; 95 % CI, 0.25 to 2.19), systemic embolism (RR, 0.21; 95 % CI, 0.01 to 4.58), the composite of stroke and systemic embolism (RR, 0.64; 95 % CI, 0.17 to 2.32), major bleeding (RR, 0.43; 95 % CI, 0.16 to 1.19), or all-cause mortality (RR, 0.92; 95 % CI, 0.36 to 2.31). A network meta-analysis showed no statistically significant differences across the anticoagulants in any clinical endpoint.

CONCLUSION: DOACs showed comparable efficacy and safety to VKA in managing LV thrombus, supporting their potential role as a viable alternative anticoagulation strategy.

PMID:40983289 | DOI:10.1016/j.jjcc.2025.09.012

Cardiovasc Pathol. 2025 Sep 20:107783. doi: 10.1016/j.carpath.2025.107783. Online ahead of print.

ABSTRACT

BACKGROUND: The pathologic definition for antibody-mediated rejection (AMR) includes both histopathological and immunopathological components. C4d is the most validated diagnostic marker for immunopathologic AMR; however, the clinical significance of early C4d positivity (≤1 month post-transplant) on endomyocardial biopsies (EMBs) is unknown.

METHODS: Patients who had ≥1 episode of C4d-positive EMB within the first month after heart transplantation were selected, the coexistence with acute cellular rejection (ACR) and the correlations of C4d positivity with histopathologic features of AMR, clinical graft dysfunction, presence of donor specific antibodies (DSAs), and clinical outcomes were examined.

RESULTS: 112 EMBs from 46 patients were qualified and included in the study. 19 patients had single C4d-positive EMB whereas 27 patients developed multiple (2-4) episodes of C4d positivity within the first month. 40% of C4d-positive EMBs showed concurrent ACR (26 with G1R, 6 with G2R). The C4d positivity correlated well with the histopathologic AMR, with 73% of C4d-positive EMBs showing all or partial histologic features of AMR. Only 29% of the C4d-positive EMBs were associated with clinical graft dysfunction, indicating that most early C4d-positive EMBs were clinically asymptomatic. DSAs were found positive in 28 patients (61%), with preformed DSAs being more common than de novo DSAs. Although no cardiac allograft vasculopathy was observed from any patient, two pediatric patients died of AMR shortly after transplantation whereas three adult patients passed away mostly because of infection.

CONCLUSION: Heart recipients with C4d-positive EMBs within the first month post-transplant were mainly clinical asymptomatic, combined considerations including clinical, pathological, and serological evaluation should be conducted for the best management of AMR.

PMID:40983256 | DOI:10.1016/j.carpath.2025.107783

J Heart Lung Transplant. 2025 Sep 20:S1053-2498(25)02276-4. doi: 10.1016/j.healun.2025.09.009. Online ahead of print.

ABSTRACT

Cardiac allografts from donation after circulatory death (DCD) donors have helped increase the donor pool for heart transplantation. Techniques that reanimate the heart, such as ex situ perfusion or thoracoabdominal normothermic regional perfusion (TA-NRP), are typically employed. We recently described a novel method for the "reanimation-less" rapid recovery of DCD hearts for transplantation. Here, we highlight using our rapid recovery with extended ultra-oxygenation preservation (REUP) technique combined with 10C static cold storage to recover an older donor allograft (45 years of age) with a prolonged 8-hour ischemic time (477 minutes). The recipient underwent successful heart transplantation with subsequent normal biventricular function and excellent postoperative outcomes out to 8 months following surgery.

PMID:40983135 | DOI:10.1016/j.healun.2025.09.009

J Cardiovasc Pharmacol Ther. 2025 Jan-Dec;30:10742484251380914. doi: 10.1177/10742484251380914. Epub 2025 Sep 22.

ABSTRACT

BackgroundThe therapeutic potential of the human amnion has been known since the early twentieth century. Subsequent study has revealed the further therapeutic potential of all elements of the amnion-membrane, cells, fluid-in the treatment of cardiac disease.Materials and MethodsA systematic review was performed utilizing PubMed/MEDLINE and Embase with search terms including "amniotic fluid," "cardiovascular disease," "cardiac disease," "amnion," "amniotic membrane," and "heart." Results were reviewed by each author to ensure inclusion of all relevant articles. Animal studies were included for evaluation of existing preclinical models, and the few available clinical studies of amniotic products were included.ResultsPreclinical studies addressing organ function, assessment, and enhancement of cardiac performance in response to injury, and regenerative potential are included, as are the few clinical studies utilizing amniotic products for the treatment of cardiac disease. Therapeutic approaches include reduction of inflammation, immunomodulation, and the promotion of myocardial regeneration via cellular therapy to target the most common mechanisms underlying myocardial injury.ConclusionsThe components of the human amnion have anti-inflammatory, immunomodulatory, and pro-differentiation abilities which lend the ability to attenuate myocardial ischemia-reperfusion injury, temper cardiac fibrosis, and promote activation of progenitor cells to induce regeneration. Preclinical studies have focused heavily on cellular therapy, but clinical experience has yielded little success. The acellular components of the amnion have fueled more recent investigation and represent a new source of enthusiasm for clinical translation of amniotic products in the treatment of cardiac disease.

PMID:40982306 | DOI:10.1177/10742484251380914