Impact of Restrictive Cardiac Allograft Physiology on Heart Re‐Transplantation Outcomes
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Wiley
2025
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| author | Masaki Tsuji Jignesh K. Patel Michelle M. Kittleson David H. Chang Evan P. Kransdorf Andriana P. Nikolova Lily K. Stern Mason Lee Jon A. Kobashigawa |
| author_facet | Masaki Tsuji Jignesh K. Patel Michelle M. Kittleson David H. Chang Evan P. Kransdorf Andriana P. Nikolova Lily K. Stern Mason Lee Jon A. Kobashigawa Masaki Tsuji Jignesh K. Patel Michelle M. Kittleson David H. Chang Evan P. Kransdorf Andriana P. Nikolova Lily K. Stern Mason Lee Jon A. Kobashigawa |
| collection | Wiley Open Access |
| contents | Impact of Restrictive Cardiac Allograft Physiology on Heart Re‐Transplantation Outcomes Masaki Tsuji Jignesh K. Patel Michelle M. Kittleson David H. Chang Evan P. Kransdorf Andriana P. Nikolova Lily K. Stern Mason Lee Jon A. Kobashigawa Clinical Transplantation ABSTRACTBackgroundHeart re‐transplantation (re‐HT) is the last treatment option for end‐stage graft failure, with cases due to severe cardiac allograft vasculopathy (CAV) showing a better prognosis compared to other indications. However, the effects of restrictive cardiac allograft physiology (RCP), classified as severe CAV, on re‐HT outcomes remain unclear.MethodsWe assessed patients with severe CAV who underwent re‐HT between 2010 and 2024. RCP was defined as symptomatic heart failure with restrictive echocardiographic values (E‐to‐A velocity ratio >2 and deceleration time <150 ms) or hemodynamic values (mean right atrial pressure >12 mmHg, pulmonary capillary wedge pressure >25 mmHg, and cardiac index <2.0 L/min/m2). The primary outcome was death or third re‐HT.ResultsWe included 86 patients; 34 patients were complicated with RCP and 52 patients were without RCP. During the follow‐up period, two patients underwent a third re‐HT, and 16 died. The most frequent cause of death among those with and without RCP was malignancy and cardiovascular death, respectively. The probability of survival from all‐cause death or third re‐HT was significantly worse for those with RCP than for those without RCP (p = 0.021). Additionally, RCP was independently associated with an increased risk of death or third re‐HT (hazard ratio: 3.36; 95% confidence interval: 1.16–9.75; p = 0.026).ConclusionsAmong patients with severe CAV, those with RCP appear to have a worse prognosis after re‐HT compared to those without RCP. This finding might be considered in the candidate selection for re‐HT. 10.1111/ctr.70124 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.70124 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70124 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Impact of Restrictive Cardiac Allograft Physiology on Heart Re‐Transplantation Outcomes Masaki Tsuji Jignesh K. Patel Michelle M. Kittleson David H. Chang Evan P. Kransdorf Andriana P. Nikolova Lily K. Stern Mason Lee Jon A. Kobashigawa Clinical Transplantation Impact of Restrictive Cardiac Allograft Physiology on Heart Re‐Transplantation Outcomes Masaki Tsuji Jignesh K. Patel Michelle M. Kittleson David H. Chang Evan P. Kransdorf Andriana P. Nikolova Lily K. Stern Mason Lee Jon A. Kobashigawa Clinical Transplantation ABSTRACTBackgroundHeart re‐transplantation (re‐HT) is the last treatment option for end‐stage graft failure, with cases due to severe cardiac allograft vasculopathy (CAV) showing a better prognosis compared to other indications. However, the effects of restrictive cardiac allograft physiology (RCP), classified as severe CAV, on re‐HT outcomes remain unclear.MethodsWe assessed patients with severe CAV who underwent re‐HT between 2010 and 2024. RCP was defined as symptomatic heart failure with restrictive echocardiographic values (E‐to‐A velocity ratio >2 and deceleration time <150 ms) or hemodynamic values (mean right atrial pressure >12 mmHg, pulmonary capillary wedge pressure >25 mmHg, and cardiac index <2.0 L/min/m2). The primary outcome was death or third re‐HT.ResultsWe included 86 patients; 34 patients were complicated with RCP and 52 patients were without RCP. During the follow‐up period, two patients underwent a third re‐HT, and 16 died. The most frequent cause of death among those with and without RCP was malignancy and cardiovascular death, respectively. The probability of survival from all‐cause death or third re‐HT was significantly worse for those with RCP than for those without RCP (p = 0.021). Additionally, RCP was independently associated with an increased risk of death or third re‐HT (hazard ratio: 3.36; 95% confidence interval: 1.16–9.75; p = 0.026).ConclusionsAmong patients with severe CAV, those with RCP appear to have a worse prognosis after re‐HT compared to those without RCP. This finding might be considered in the candidate selection for re‐HT. 10.1111/ctr.70124 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Impact of Restrictive Cardiac Allograft Physiology on Heart Re‐Transplantation Outcomes |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70124 |