Late graft failure in heart transplant recipients: incidence, risk factors and clinical outcomes

Abstract

Late graft failure is frequent after heart transplantation, as it is associated with poor outcomes. Rejection and cardiac allograft vasculopathy are the most frequent underlying causes.

Heart transplantation turns 50 and is going strong

“…Cardiac allograft vasculopathy affects 40% of patients after 5 years and is by far the leading cause of late graft failure . While treatment with statins and tight risk factor control are key, it has become clear that different immunosuppressive regimens are associated with different risks of CAV development.…”

Optimizing outcomes after heart transplantation

“…For example, in an analysis of the ISHLT Registry, we observed that younger patients were at considerably greater risk for death from acute rejection, CAV and graft failure, potentially implying inadequate immunosuppression, whereas older patients had greater risk for death from infection and malignancy, consequences of immunosuppression . The data from A Coruña suggest we should also be vigilant about rejection and by extension adequate immunosuppression in the long term; however, data from the ISHLT suggest that malignancy, a consequence of immunosuppression, is the most common cause of death beyond 5 years post‐HTx . There is clearly a great need for additional studies of the relative risks for different post‐HTx outcomes according to time post‐transplant and individual patient characteristics.…”

“…However, data from the International Society for Heart and Lung Transplantation (ISHLT) Registry suggest that long‐term adult post‐HTx outcomes have not improved appreciably since reporting to this worldwide registry begun in the early 1980s and that mortality at 13 years is >50% . In this issue of the journal, the large HTx group from A Coruña, Spain, report specifically on late graft failure in 547 HTx recipients aged 16 years or older . The study is laudable for its large sample size and detailed analysis of both graft failure and its predictors, and outcomes post‐graft failure and their predictors.…”

“…The study is laudable for its large sample size and detailed analysis of both graft failure and its predictors, and outcomes post‐graft failure and their predictors. Over a mean follow‐up of >8 years, 32% of subjects were hospitalized for late graft failure (3.6% per year), manifesting as HF, often with preserved EF, and associated with increased risk for death and need for retransplantation . Cardiac allograft vasculopathy (CAV), cellular rejection and antibody‐mediated rejection were detected in 51%, 45% and 19% of patients admitted, respectively.…”

“…5 In this issue of the journal, the large HTx group from A Coruña, Spain, report specifically on late graft failure in 547 HTx recipients aged 16 years or older. 7 The study is laudable for its large sample size and detailed analysis of both graft failure and its predictors, and outcomes post-graft failure and their predictors. Over a mean follow-up of >8 years, 32% of subjects were hospitalized for late graft failure (3.6% per year), manifesting as HF, often with preserved EF, and associated with increased risk for death and need for retransplantation.…”