Primary Graft Dysfunction (PGD) is an early post-lung transplant (LTx) inflammatory condition primarily driven by lung ischemia-reperfusion injury (LIRI). Neutrophils are key mediators of LIRI, but their phenotypic diversity and maturation state remain poorly characterized. In other inflammatory settings, early expansion of immature neutrophils has been linked to increased tissue injury and worse clinical outcomes. Whether immature neutrophils increase following LTx and contribute to PGD severity remains unclear.

Postoperative right ventricular (RV) adaptation to left ventricular assist device (LVAD) implantation remains poorly characterized. RV-pulmonary artery (PA) coupling, defined as the ratio of end-systolic to arterial elastance (Ees/Ea), provides a framework to assess RV performance under altered loading conditions. This study examined intraoperative RV adaptations to LVAD implantation using RV conductance catheters and three-dimensional echocardiography.

Since the implementation of the new allocation system for heart transplantation in 2018, various unintended consequences have emerged. In response, a recent policy amendment was proposed that took effect in September 2025 requiring transplant programs to document failure of inotropic therapy prior to the use of percutaneous endovascular mechanical circulatory support or intra-aortic balloon pump. The goal of this new policy is to reduce inflation and waitlist congestion of status 2 and help to further risk stratify patients within the current Status 2 tier by waitlist urgency. This viewpoint highlights the potential anticipated challenges in response to this policy including rising exception requests, gaming of timing, potential delays in appropriate escalation of mechanical circulatory support, and equity considerations.

The Lung Transplant Consortium (LTC) sponsored by the National Heart, Lung, and Blood Institute (NHLBI) is a 20-center collaboration among lung transplant programs in North America conducting both smaller multicenter projects and one consortium-wide prospective observational cohort study called the Prospective Multicenter Research on Donor and Recipient Management Strategies to Improve Lung Transplant Outcomes (PROMISE) Lung Study - for more information about the LTC, visit their website: https://lungtransplantconsortium.org/. The LTC conducted a meeting in April 2025 to strategize how to maximize the benefits of the PROMISE study to advance the field of lung transplant. This paper summarizes the key themes that emerged from the meeting: leveraging PROMISE data elements, including biomarkers, imaging, and PROs; clinical syndrome and consensus definitions; variation in management and management strategies; and future interventional trials leveraging the PROMISE consortium. The PROMISE study will serve as the platform for establishing best practices in lung transplant, inform the validity of newly identified syndromes, and support analysis of patient-reported outcomes, image data, and biosamples. The PROMISE study and LTC create a critically needed research platform and multicenter collaborative structure that may be adapted to conduct future multicenter clinical trials that will advance lung transplant medicine.

Uncovering sex-based differences in immunologic outcomes following heart transplantation (HT) can inform risk stratification and precision immunosuppressive strategies. However, granular clinical-translational understanding of sex-specific molecular risk in the modern era is lacking. Here, we investigate the relationship between sex, acute rejection, and cardiac allograft vasculopathy (CAV) in adults and children following HT. We then decode cell-specific gene expression patterns in healthy individuals and HT recipients to identify discordant pathways that inform immunologic risk.

Multimodal molecular testing with gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA) is increasingly used for rejection surveillance, but less is known about their joint ability to predict future clinical events.

In a phase 2 study of inoperable chronic thromboembolic pulmonary hypertension (CTEPH), macitentan 10 mg improved hemodynamics and exercise capacity.

Ly49⁺ CD8⁺ T cells restricted by Qa-1 or major histocompatibility complex (MHC)/peptide can function as immune suppressors in autoimmune diseases and chronic activation-associated tissue damage. In organ transplantation, a C-X-C motif chemokine receptor 5 (CXCR5⁺) Ly49⁺ CD8⁺ T cell subset reportedly suppresses CD4⁺ T cell activation via Qa-1 recognition, thereby inhibiting donor-specific antibody (DSA) production and promoting heart graft survival, particularly under CD80/86-CD28 co-stimulation blockade. However, their precise role in anti-allogeneic responses remains unclear.

Long-term outcomes after pediatric heart transplant (pHT) are rarely reported owing to young programs and loss of follow-up after transition to adult care. We leveraged our program age, center volume, and linked electronic medical record (EMR) to analyze 50-year outcomes after pHT, including events after adult care transfer.