Front Pediatr. 2025 Sep 4;13:1622729. doi: 10.3389/fped.2025.1622729. eCollection 2025.
ABSTRACT
Kawasaki disease (KD), or mucocutaneous lymph node syndrome, is a rare systemic inflammatory condition predominantly affecting children under 5 years of age. Complications such as giant coronary artery aneurysms, although rare due to advancements in treatment, remain life-threatening. Coronary artery bypass grafting (CABG) has been a well-established treatment for severe coronary lesions caused by KD. In rare cases of ischemic cardiomyopathy in pediatric patients, heart transplantation may be the only option. We report a case of a 15-year-old male with a history of KD diagnosed at 9 months of age, complicated by giant coronary aneurysms of the left anterior descending and right coronary arteries, who underwent a successful double CABG using the left internal mammary artery) and a saphenous vein graft.
PMID:40980138 | PMC:PMC12443707 | DOI:10.3389/fped.2025.1622729
Eur Heart J Suppl. 2025 Feb 11;27(Suppl 7):vii33-vii36. doi: 10.1093/eurheartjsupp/suaf048. eCollection 2025 Aug.
ABSTRACT
Hypertension remains a major public health challenge with inadequate control globally. The May Measurement Month (MMM) global survey initiated by the International Society of Hypertension was implemented in Greece in 2022 aiming to raise hypertension awareness and control. Adult volunteers were recruited through opportunistic screening in 11 urban areas. Information on medical history and three sitting blood pressure (BP) measurements were obtained using validated automated upper-arm devices, and the data were submitted online through a custom-designed app of the global MMM survey. Hypertension was defined as average systolic BP at least 140 mmHg and/or diastolic 90 mmHg, and/or self-reported use of drugs for hypertension. A total of 6353 individuals were included (mean age 54.8 ± 16.2 years, 49% men, 30.5% current smokers, 11.5% had diabetes, 5.1% cardiovascular disease). The prevalence of hypertension (42.6%) was higher in men (48.8%) and in older individuals (74%). Among individuals with hypertension, 27.5% were unaware of their diagnosis, 22.2% were treated but uncontrolled (≥140 mmHg systolic and/or ≥90 mmHg diastolic BP), and 47.9% were treated and controlled. Among treated hypertensives, 58.2% were on monotherapy and at least one-third of them were uncontrolled. The prevalence of hypertension in Greece seems to be high and is often undiagnosed, untreated, and uncontrolled. Public health initiatives and campaigns aiming at improving hypertension diagnosis and control need to be implemented.
PMID:40980008 | PMC:PMC12449183 | DOI:10.1093/eurheartjsupp/suaf048
Transplant Direct. 2025 Sep 18;11(10):e1853. doi: 10.1097/TXD.0000000000001853. eCollection 2025 Oct.
ABSTRACT
BACKGROUND: There is limited evidence on heart and kidney transplants using donation after circulatory death (DCD) donors, especially regarding graft outcomes. However, little is known about the use of DCD donors for simultaneous heart and kidney transplants (SHKTs) compared with SHKTs using donation after brain death (DBD) donors.
METHODS: From May 22, 2020, to September 30, 2023, 1129 adult patients received SHKTs (DCD, N = 91 versus DBD, N = 1038), identified using the United Network for Organ Sharing database, excluding other multiorgan transplants and retransplants. A propensity score matching was performed using characteristics. Ninety-one DCD- and 273 DBD-matched cases were compared.
RESULTS: In the unmatched cohort, DCD recipients were older (DCD: 60 versus DBD: 58 y, P = 0.03), had a lower rate of dialysis at transplant (27% versus 40%, P = 0.03), and were of status 1 to 2 (43% versus 72%, P < 0.001). In the matched cohort, kidney delayed graft function (27% versus 22%, P = 0.29) was comparable, as were recipient survival (P = 0.19), heart graft survival (P = 0.19), and kidney graft survival (P = 0.17). In multivariate Cox proportional hazards analysis, donor type (DCD) was not associated with an increased risk of mortality (hazard ratio, 1.69; 95% confidence interval, 0.90-3.16; P = 0.10). Subgroup analysis showed that survival and freedom from graft failures were comparable between different modes of DCD recovery.
CONCLUSIONS: SHKT using DCD donors yields comparable survival and graft outcomes to those using DBD donors. These findings may help donor selection in heart transplant candidates with kidney dysfunction.
PMID:40979588 | PMC:PMC12448170 | DOI:10.1097/TXD.0000000000001853
JHLT Open. 2025 Aug 22;10:100378. doi: 10.1016/j.jhlto.2025.100378. eCollection 2025 Nov.
ABSTRACT
BACKGROUND: Although survival is good after pediatric heart transplantation (HTx) and steadily improving after pediatric lung transplantation (LTx), it remains unclear whether this also translates into a satisfactory health-related quality of life (HRQOL).
METHODS: This scoping review summarizes the findings on pediatric patients' overall HRQOL after HTx or LTx published in PubMed up to January 23, 2025. Data on study design, population characteristics, measurement methods, HRQOL definitions, and results are tabulated and described narratively for HTx and LTx separately.
RESULTS: Twenty-seven papers covering 24 original studies (3 qualitative and 21 quantitative) report on pediatric HTx' patients HRQOL. Most quantitative studies indicate that their HRQOL is generally good, both during childhood and into adulthood, and is comparable to that of healthy peers or children with other chronic conditions. However, the 3 qualitative studies portray more varied experiences, with the post-Tx trajectory being marked by ups and downs. Only 4 papers focus on pediatric LTx patients' HRQOL. The 2 prospective studies show a favorable HRQOL early post-Tx, while the 2 qualitative studies also report more mixed experiences. Nevertheless, studies are generally small, do not define HRQOL, use diverse measures, and exhibit substantial exclusion and refusal rates.
CONCLUSIONS: While most studies present an optimistic view of pediatric patients' HRQOL, these findings should be interpreted with caution due to the methodological heterogeneity and selection bias present within the current evidence base. This review offers several directions for methodological improvement in future research, aiming to deepen our understanding of HRQOL in ALL pediatric cardiothoracic transplant patients.
PMID:40979527 | PMC:PMC12446668 | DOI:10.1016/j.jhlto.2025.100378
JHLT Open. 2025 Aug 7;10:100368. doi: 10.1016/j.jhlto.2025.100368. eCollection 2025 Nov.
ABSTRACT
Implementation of the composite allocation score (CAS) has improved, but not eliminated, waitlist mortality amongst lung transplant candidates. Identifying risk factors for clinical deterioration is important to stratify patients who may benefit from closer monitoring or increased support. We performed a UNOS registry-based study of lung transplant candidates listed between March 9, 2022 to March 8, 2024; analysis was stratified by listings before or after CAS implementation. Univariate and multivariate logistic regression analyses were performed to identify factors associated with waitlist removal for clinical decompensation or death. Traits associated with waitlist removal during the pre-CAS era were short stature, ECMO support at listing, and amount of supplemental oxygen. Following CAS implementation, ECMO support, low BMI, poor functional status, short stature, and ABO blood type O were significantly associated with waitlist removal. Close monitoring of patients with increased likelihood for waitlist removal, especially patients with multiple risk factors, may be appropriate.
PMID:40979525 | PMC:PMC12444147 | DOI:10.1016/j.jhlto.2025.100368
JHLT Open. 2025 Aug 14;10:100374. doi: 10.1016/j.jhlto.2025.100374. eCollection 2025 Nov.
ABSTRACT
Uncontrolled donation after circulatory death (uDCD) represents a promising yet underutilized approach to expanding the lung donor pool amid persistent organ shortages. Since the first successful lung transplantation from a uDCD donor in 2001, increasing clinical experience and advancements in organ preservation have demonstrated its feasibility. This review critically explores historical evolution, physiological basis, preservation techniques, ethical and legal considerations, and clinical outcomes of uDCD lung transplantation. The lung's unique ability to maintain viability through passive oxygen diffusion in the absence of perfusion supports its potential in the uDCD context. Compared to donors after brain death (DBD), uDCD donors may avoid systemic inflammatory response, potentially preserving graft quality. However, concerns persist regarding ischemia-reperfusion injury and mitochondrial dysfunction, highlighting the need for mitigation strategies such as ex vivo lung perfusion and normothermic ventilation. Ethical and legal challenges-particularly those related to the determination of death and consent-remain key obstacles. Organizational demands, including rapid coordination between prehospital, hospital teams and transplant teams, further limit broader implementation. Despite these barriers, reported outcomes are encouraging: to date, over 70 transplants from uDCD donors have been documented, with 1-year survival rates ranging from 71% to 87.5% and long-term outcomes comparable to DBD transplants. Integration of uDCD into routine clinical practice will require standardized protocols, robust public engagement, and institutional commitment. When appropriately implemented, uDCD lung transplantation offers a viable opportunity to increase donor availability and improve access to life-saving treatment.
PMID:40979524 | PMC:PMC12444154 | DOI:10.1016/j.jhlto.2025.100374
JHLT Open. 2025 Aug 19;10:100373. doi: 10.1016/j.jhlto.2025.100373. eCollection 2025 Nov.
ABSTRACT
BACKGROUND: Acute cellular rejection (ACR) is a common complication following heart transplantation (HTx). This study examined the association between tacrolimus whole-blood concentrations and endomyocardial biopsy (EMB)-proven ACR in adult HTx recipients.
METHODS: We conducted a retrospective analysis of 41 adult HTx recipients enrolled in the HEARTBiT study at St. Paul's Hospital (Vancouver, Canada) between August 2018 and February 2020. A total of 315 EMB visits were analyzed and matched with tacrolimus whole-blood trough concentrations measured within ±1 day using liquid chromatography-tandem mass spectrometry. Patients were stratified into 2 post-transplant intervals: 0 to 90 days and 91 to 180 days, based on BC Clinical Guidelines for Transplant Medications for target tacrolimus levels.
RESULTS: During the first 90 days post transplant, tacrolimus concentrations were significantly lower in 2R rejection episodes compared to both 0R (p = 0.006) and 1R (p = 0.013) groups. No significant differences in tacrolimus levels were observed beyond 90 days. In a linear mixed effects model adjusting for time post transplant (days) and tacrolimus dose, 2R rejection remained independently associated with lower tacrolimus concentrations (-2.73 µg/ml; p = 0.021), despite slightly higher dosing at those visits (+0.10 mg/d; p = 0.047). Clinical review confirmed no concurrent cytomegalovirus infections or major changes in other immunosuppressive therapies.
CONCLUSIONS: Lower tacrolimus concentrations during moderate ACR episodes were not attributable to underdosing or clinical confounders, suggesting the role of altered pharmacokinetics or patient-specific factors. Taken together, our results emphasize the clinical relevance of tailoring tacrolimus targets to individual pharmacokinetics, especially in early-phase post-transplant care.
PMID:40979523 | PMC:PMC12444152 | DOI:10.1016/j.jhlto.2025.100373
JHLT Open. 2025 Aug 20;10:100376. doi: 10.1016/j.jhlto.2025.100376. eCollection 2025 Nov.
ABSTRACT
Heart and lung transplantation are life-saving treatments for patients with end-stage organ disease. Donor-derived infections are common and can be expected or unexpected. The lung is exposed to the external environment and transplanted with an intact microbiome, which can include community and nosocomial bacterial, viral, and fungal pathogens. This includes not only well-recognized scenarios, such as bacteria with or without multidrug resistance, respiratory viruses including SARS-CoV-2, molds, and tuberculous/nontuberculous mycobacteria, but also emerging pathogens, such as the mollicutes. The heart is the only transplanted organ that is a muscle and in direct contact with the bloodstream. These factors make donor-derived endocarditis, toxoplasmosis, and Chagas disease particularly relevant. This article aims to review some key established and emerging donor-derived infections that are of particular significance to heart and lung transplant recipients.
PMID:40979522 | PMC:PMC12444161 | DOI:10.1016/j.jhlto.2025.100376
Front Med (Lausanne). 2025 Sep 4;12:1650859. doi: 10.3389/fmed.2025.1650859. eCollection 2025.
ABSTRACT
BACKGROUND: Several studies suggest that C-peptide (CP) is involved in regulating lipolysis, adipokine release, and other functions in the adipose tissue. On the other hand, organ-specific adipose tissues, such as the epicardial adipose tissue (EAT), have been reported as an independent cardiovascular risk factor in patients on dialysis. This study aimed to evaluate the association between CP, EAT volume, and coronary artery calcification (CAC) as markers of cardiovascular risk, on subjects with type 2 diabetes receiving insulin and dialysis.
METHODS: This is a retrospective study on 62 patients with chronic kidney disease (CKD) stage 5 on dialysis awaiting kidney transplantation and referred for cardiovascular risk stratification at the Emory University Hospital. Computed tomography (CT) was used to assess CAC and to measure EAT volume. Demographic and anthropometric data were collected from all patients through record review.
RESULTS: The mean patient age was 43 ± 11 and 55% were women. None of the serum analytical parameters correlated with CP. Subjects with higher BMI exhibited higher levels of CP. EAT volume strongly correlated with CP levels, and it was significantly correlated with CAC. On the contrary, no correlation was found between CP and CAC.
CONCLUSION: The significant association between EAT volume and CP suggests a potential role of CP in the cardiovascular physiopathology of patients with ESKD on dialysis. Insufficient statistical power was probably the cause of the lack of association of CP with CAC. Observational prospective studies are required to characterize CP as a cardiovascular risk marker in patients with ESKD.
PMID:40978759 | PMC:PMC12443673 | DOI:10.3389/fmed.2025.1650859
Front Pharmacol. 2025 Sep 4;16:1566674. doi: 10.3389/fphar.2025.1566674. eCollection 2025.
ABSTRACT
BACKGROUND: Myocardial ischemia-reperfusion injury (IRI) is the major cause of primary graft dysfunction in heart transplantation, which is characterized by mitochondrial dysfunction. Hyperoside is a bioactive compound that has been reported to have pharmacological potential for cardiac and mitochondrial protection. Here, we investigated the protective effect of hyperoside during myocardial IRI and identified the underlying mechanisms.
METHODS: In this study, we established IRI in an in vivo murine heterotopic heart transplantation model and an in vitro hypoxia-reoxygenation cell model. Inflammatory responses, oxidative stress level, mitochondrial function, and cardiomyocyte apoptosis were evaluated.
RESULTS: We found that hyperoside pretreatment alleviated through reducing MDA content, LDH activity, TUNEL positive cells, serum cTnI level, Bax protein expression and the level of inflammatory cytokines, and increasing SOD activity and Bcl-2 protein expression. Furthermore, hyperoside pretreatment improved Opa1-mediated mitochondrial fusion, upregulated mitochondrial ATP content and downregulated NADP+/NADPH and GSSG/GSH ratios. Opa1 inhibitor blunted the protective effects of hyperoside. Mechanistically, Co-immunoprecipitation experiments showed the binding property between Tom70 and Opa1, siRNA knockdown, AAV-mediated loss-of-function and gain-of-function approaches suggested that hyperoside-promoted Opa1-mediated mitochondrial fusion required the upregulation of Tom70.
CONCLUSION: Collectively, we demonstrated for the first time that hyperoside administration alleviates myocardial IRI by promoting Opa1-mediated mitochondrial fusion in vivo and in vitro. The Tom70-Opa1 pathway was essential for cardioprotective effects of hyperoside treatment. The results in our study indicated that hyperoside or promotion of mitochondrial fusion might be a new potential option for the prevention and treatment of IRI in heart transplantation.
PMID:40978492 | PMC:PMC12443569 | DOI:10.3389/fphar.2025.1566674
Hepatobiliary Surg Nutr. 2025 Jun 1;14(3):423-441. doi: 10.21037/hbsn-24-349. Epub 2024 Sep 23.
ABSTRACT
BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a multimodal approach for almost all types of surgical procedures, including liver transplantation (LTx). We developed an ERAS protocol for LTx based on previous experience and assessed it using benchmarks from the German Institute for Quality Management and Transparency in Healthcare (IQTIG).
METHODS: An ERAS protocol was developed and implemented in our center since 2018 for LTx, including preoperative, intraoperative, and postoperative procedures. From January 2021 to December 31st 2022, we conducted a prospective analysis including donor and recipient demographics, Model for End-Stage Liver Disease (MELD) score and medical history. Perioperative management, such as operative time, anhepatic phase time, intensive care unit (ICU) stay, morbidity and mortality as well as postoperative hospitalization, readmission and 1-year patient survival, were collected as outcome measures.
RESULTS: Sixty-eight consecutive liver transplant recipients were included. Mean age of the donors was 47 (36-55.5) years old, type of donation was in 41 donation after brain death (DBD), 26 donation after controlled circulatory death (DCD) and 1 donation after brain and cardiac death (DBCD). Mean age of the patients was 49.6 years (range, 26-68 years), 81% were male. The mean body mass index (BMI) of the recipients was 24 kg/m2 (range, 15-37 kg/m2), mean MELD score was 15 (range, 6-39), 3 patients had a MELD score higher than 30. Fifty-three patients suffered from hepatitis B virus (HBV) related cirrhosis. Twenty-eight patients had hepatocellular carcinoma (HCC); 5 patients were diagnosed with alcohol related cirrhosis and primary biliary cirrhosis, autoimmune disease and drug induced cirrhosis, undefined cirrhosis, respectively. The mean operation time in our cohort was 6.73 hours, and the average anhepatic phase time was 68 minutes. No patient had intraoperative hypothermia. Tracheal extubation was performed in the ICU department within 6 hours post operation and the average ICU/intermediate care (IMC) unit stay was 4.5 days (range, 2-14 days). None of the patients required re-intubation. Postoperative complications with a CDC classification > II were seen in 16 patients (23.5%). Mean hospital stay was 21.7 days and readmission rate was 13 (19%). Neither acute rejection nor postoperative mortality during the hospital stay was recorded. One patient died from acute myocardial infarction after discharge.
CONCLUSIONS: We developed an ERAS protocol in LTx, consisting of preoperative, perioperative and postoperative management and assessed the quality using benchmarks from IQTIG. Our study revealed that the proposed ERAS approach in LTx is feasible offering the opportunities of enhanced recovery and quality management.
PMID:40978335 | PMC:PMC12443639 | DOI:10.21037/hbsn-24-349
Am J Prev Cardiol. 2025 Aug 22;23:101262. doi: 10.1016/j.ajpc.2025.101262. eCollection 2025 Sep.
ABSTRACT
Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism resulting in lifelong elevated levels of low-density lipoprotein cholesterol and early atherosclerotic cardiovascular disease. Although FH can be identified at young ages, it remains frequently undetected, underdiagnosed, and undertreated in the United States and around the world. Despite compelling data to support screening for FH in children, and universal lipid screening guidelines endorsed by the National Heart, Lung and Blood Institute and the American Academy of Pediatrics, screening practices in the United States remain controversial and suboptimal. The Family Heart Foundation launched its LEAD (Leverage Evidence and Data) Pediatric Initiative at the 2024 Family Heart Foundation 10th Annual Global Summit to help understand testing barriers, propose innovative solutions, and integrate improvement science to measure outcomes. Presentations highlighted common challenges with pediatric lipid screening and demonstrated creative process solutions to improve screening prevalence for children. This state-of-the-art review discusses common barriers to pediatric lipid screening, identifies process solutions, and explores innovative practices to increase the frequency of universal pediatric lipid screening.
PMID:40978301 | PMC:PMC12445570 | DOI:10.1016/j.ajpc.2025.101262
Am J Stem Cells. 2025 Aug 25;14(3):146-155. doi: 10.62347/YKPS8756. eCollection 2025.
ABSTRACT
The association of bone marrow stem cells (BMSCs) with cardiac function outcomes and treatment outcomes in heart failure (HF) patients with low ejection fraction (EF) has been heterogeneous across studies. This systematic review aimed to investigate the effect of BMSCs on functional, clinical, quality of life, and major adverse cardiovascular events (MACE) outcomes in HF patients with low EF. PubMed, Scopus, Clinicaltrial.gov, Cochrane Library, Google Scholar, and Web and reference databases were searched for articles that examined the effect of BMSCs therapy on improving cardiac outcomes in patients with low EF, from 2000 to 2024. Differences in left ventricular ejection fraction (LVEF), MACE, echocardiographic indices (left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV)), 6-min walk test (6-MWT), New York Heart Association (NYHA) class and immunologic responses were defined as outcomes. Low EF was defined as an EF <45%. Finally, 14 RCTs involving 710 HF patients with low EF were included. BMSCs transplantation was associated with improvements in echocardiographic parameters, EF rate, and NYHA class in most studies (9 of 14) compared to the control group, regardless of the time of outcome assessment (3 or 6 months). It also significantly improved the 6-MWT in most studies. Improvements in parameters and functional outcomes were similar at both evaluation periods, 6 and 12 months. The BMSCs transplantation was not significantly associated with the incidence of MACE and immunological responses. The results of this systematic review supported the positive role of BMSCs transplantation in improving echocardiographic parameters, EF rate, NYHA class, and 6-MWT in HF patients with low EF. BMSCs transplantation was not significantly associated with the incidence of MACE and immunological responses.
PMID:40978279 | PMC:PMC12444438 | DOI:10.62347/YKPS8756
Am J Stem Cells. 2025 Aug 25;14(3):134-145. doi: 10.62347/YZAN4747. eCollection 2025.
ABSTRACT
OBJECTIVES: To evaluate the in vivo developmental and therapeutic potential of a novel parthenogenetic embryonic stem cell line (NF-pES), which contains genomes from both non-growing and grown oocytes.
METHODS: NF-pES cells were injected into mouse blastocysts to generate chimeric mice, and their contribution to various tissues was assessed. Skeletal muscle differentiation potential was examined through teratoma assays and analysis of muscle tissue in chimeric mice. For therapeutic assessment, a skeletal muscle injury model was established by cardiotoxin and irradiation treatment of the tibialis anterior muscle. NF-pES-derived precursor cells, obtained through in vitro induction and differentiation, were transplanted into the injured muscle.
RESULTS: Notably, NF-pES cells contributed extensively to multiple somatic lineages in chimeric mice, with high levels of chimerism observed in the heart (83.36%) and bone marrow (50.44%). These levels are comparable to those achieved with embryonic stem cells derived from fertilized embryos. Importantly, NF-pES cells demonstrated robust myogenic differentiation capacity, as evidenced by their contribution to skeletal muscle tissues in both teratoma formation assays and in vivo chimeric muscle integration. Following in vitro induction, NF-pES-derived precursors were transplanted into the injured tibialis anterior muscle of recipient mice to assess their regenerative potential in vivo. One month after transplantation, immunohistochemical analysis confirmed the successful engraftment of donor-derived cells within the host muscle tissue. These donor-derived cells expressed markers of terminal myogenic differentiation and were incorporated into mature skeletal muscle fibers.
CONCLUSIONS: NF-pES cells exhibit strong developmental capacity and therapeutic potential for skeletal muscle regeneration, suggesting their value in future regenerative medicine applications.
PMID:40978278 | PMC:PMC12444436 | DOI:10.62347/YZAN4747
Cardiovasc Ther. 2025 Sep 13;2025:7230505. doi: 10.1155/cdr/7230505. eCollection 2025.
ABSTRACT
Myocardial fibrosis is a common pathological feature in many cardiovascular diseases, yet effective targeted therapies remain elusive. Given the emerging potential of chimeric antigen receptor T (CAR-T) cell therapy in nononcological diseases and fibroblast activation protein (FAP) as a promising target, we engineered a second-generation FAP-targeted CAR construct incorporating the 4-1BB costimulatory domain to enhance therapeutic safety. Using two delivery approaches-lentiviral vectors and lipid nanoparticles (LNPs)-we generated FAP-CAR-engineered Jurkat cells as a preliminary screening model and evaluated their CAR expression, target recognition, and in vitro cytotoxic activity. These engineered cells selectively recognized and induced apoptosis in FAP-expressing cardiac myofibroblasts without triggering excessive IL-6 secretion, supporting their potential for fibrosis-selective cytotoxicity. Our findings provide key preliminary in vitro evidence supporting the design and target-specific functionality of FAP-targeted CAR constructs incorporating the 4-1BB domain, warranting further investigation in primary T cell models for cardiac fibrosis therapy.
PMID:40977952 | PMC:PMC12450108 | DOI:10.1155/cdr/7230505
Front Immunol. 2025 Sep 5;16:1619771. doi: 10.3389/fimmu.2025.1619771. eCollection 2025.
ABSTRACT
INTRODUCTION: Plasma donor-derived cell-free DNA (dd-cfDNA) is an emerging potential tool for diagnosing lung graft injury. This study explored the relevance of dd-cfDNA levels in different graft injuries thoroughly characterized after a well-established multidisciplinary team approach. The usefulness of bronchoalveolar lavage (BAL) dd-cfDNA in complementing detection of allograft injury was also investigated.
METHODS: Plasma dd-cfDNA was measured by next generation sequence on 127 samples from patients visited consecutively, contemporaneously with a systematic analysis of surveillance transbronchial biopsy by LASHA template, BAL analysis and immunological monitoring.
RESULTS: Patients with immunological injury exhibited the highest plasma dd-cfDNA levels (median 2.67%), with a sensitivity of 100% while patients with non-immunological insults showed a sensitivity of 28%. The combination of BAL with plasma dd-cfDNA improved the sensitivity for detecting non-immunological injury from 28% to 71%. Random forest analysis showed that plasma dd-cfDNA >1% was among the most important variables in predicting death and chronic lung allograft dysfunction.
DISCUSSION: Our data suggests that plasma dd-cfDNA is a useful tool for immunological graft injury assessment. The performance of BAL dd-cf DNA needs to be validated on larger case series. The integration of plasma dd-cfDNA with other post-transplant follow-up investigations may allow more sensitive diagnoses and appropriate graft injury management.
PMID:40977742 | PMC:PMC12447569 | DOI:10.3389/fimmu.2025.1619771
J Pediatr Gastroenterol Nutr. 2025 Sep 22. doi: 10.1002/jpn3.70213. Online ahead of print.
ABSTRACT
OBJECTIVES: Hepatic steatosis impacts the quality of grafts, affecting transplant outcomes. Rising obesity rates and subsequent donor graft steatosis further influence the organ shortage crisis in pediatric liver transplantation (LT). Our study aimed to evaluate how donor steatosis modulates the outcomes of pediatric LT.
METHODS: We analyzed the United Network of Organ Sharing database for transplanted donor grafts from January 01, 2004, to April 30, 2024. We stratified pediatric (≤18 years) LT recipients into steatotic grafts, subdivided into <30% and ≥30%. Graft failure was assessed using Kaplan-Meier curves, and Cox proportional hazards models, with Lasso regression identifying key predictive variables. Gradient-boosting decision tree was used to assess the level of likelihood importance for post-LT survival.
RESULTS: Five hundred and ninety-five pediatric LT recipients were included; 62 (10.4%) received donors with steatosis levels ≥30%. Survival rates for steatotic grafts ≥30% were 93.5% at 1 year, 89.9% at 5 years, and 84.4% at 10 years, compared to 94.7%, 89.5%, and 85.2% respectively, among steatotic grafts <30% (p = 0.72, p = 0.92, and p = 0.92). Donor age (adjusted hazard ratio [aHR]: 1.01, 95% confidence interval [CI]: 1.01-1.03), donation after cardiac death (DCD) (aHR: 10.68, 95% CI: 3.27-34.86), and recipient life support (aHR: 1.95, 95% CI: 1.19-3.20) were associated with an increased risk of mortality.
CONCLUSION: Steatotic grafts in pediatric patients had acceptable outcomes. Predictors of mortality in steatotic grafts, including donor age, DCD, and recipient life support, underscore the complex interplay of multiple factors in post-LT outcomes.
PMID:40977417 | DOI:10.1002/jpn3.70213
Pediatr Surg Int. 2025 Sep 22;41(1):302. doi: 10.1007/s00383-025-06195-4.
ABSTRACT
PURPOSE: Pectus excavatum (PE) is the most common congenital chest wall deformity. While often perceived as a cosmetic issue, PE can impair cardiopulmonary function. Surgical correction has evolved from the Ravitch procedure to the minimally invasive Nuss technique, which offers reduced surgical risks and improved postoperative outcomes. However, diagnostic and therapeutic variability persists, highlighting the need for expert consensus.
METHODS: A 31-question web-based survey was distributed to CWIG members and PE specialists between November 2024 and January 2025. The survey explored five key domains: demographics, preoperative evaluation, surgical indications and timing, operative technique, and postoperative management. Responses from 100 international surgeons were analyzed.
RESULTS: The most common indications for surgery were severe deformity (88.9%), Haller index > 3.25 (78.8%), psychosocial distress (77.8%), and symptoms (77.8%). Technique selection was influenced by prior surgery (48%) and surgeon experience (45.9%). For complex cases, 90.8% preferred the double-bar technique. Most surgeons removed the bar within 2-3 years (86.6%). Postoperative pain was primarily managed with oral analgesics (64.6%) and IV pumps (47.5%). Early complications included pneumothorax (68.1%) and infections (62.8%); bar displacement (78%) was the most frequent late complication.
CONCLUSION: Despite widespread adoption of the Nuss procedure, significant variation remains in PE management. These findings emphasize the need for standardized, evidence-based guidelines to optimize patient outcomes.
PMID:40982104 | DOI:10.1007/s00383-025-06195-4
Reports (MDPI). 2025 Sep 19;8(3):185. doi: 10.3390/reports8030185.
ABSTRACT
Background and Clinical Significance: Atrial septal defects (ASDs), particularly the ostium secundum type, are congenital cardiac anomalies that can lead to serious complications if left untreated. Percutaneous closure using devices like the Amplatzer Septal Occluder (ASO) has become a widely accepted approach, although complications such as device embolization can occur. Case Presentation: We present a unique case of a 28-year-old woman who developed acute hemodynamic instability and arrhythmias following embolization of an Amplatzer device into the right ventricle during an ASD closure. Despite initial treatment with antiarrhythmic medication, the patient required urgent open-heart surgery for device retrieval and ASD closure. The surgery successfully involved pericardial patch closure of the ASD, device removal from the right ventricle, and the performance of the Kay procedure to address significant tricuspid regurgitation. Postoperative recovery was uneventful, with the patient stabilized and discharged in stable condition. Conclusions: This case highlights the critical need for rapid surgical intervention in cases of device embolization, and the importance of multidisciplinary coordination in managing such complex complications. The combination of ASD closure, device retrieval, and tricuspid valve repair led to a successful outcome, underscoring the importance of timely, decisive action in complex cardiovascular emergencies.
PMID:40981143 | PMC:PMC12452470 | DOI:10.3390/reports8030185
Thorac Cardiovasc Surg Rep. 2025 Sep 18;14(1):e29-e32. doi: 10.1055/a-2698-3658. eCollection 2025 Jan.
ABSTRACT
BACKGROUND: Ectopia cordis (EC) is an exceptionally rare congenital anomaly with a poor prognosis, particularly in resource-limited settings.
CASE DESCRIPTION: We present a newborn with complete thoracic EC who underwent surgical correction on day 5 of life. Although cardiac repositioning and soft tissue coverage were achieved, the infant died 72 hours postoperatively from septic shock, reflecting the significant challenges faced in such contexts.
CONCLUSION: This case underscores the urgent need for improved antenatal care and technical resources to enhance outcomes for complex congenital anomalies in sub-Saharan Africa.
PMID:40980777 | PMC:PMC12445977 | DOI:10.1055/a-2698-3658