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
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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/m<sup>2</sup>). The primary outcome was death or third re-HT.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We 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 (<i>p</i> = 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; <i>p</i> = 0.026).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Among 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.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Restrictive Cardiac Allograft Physiology on Heart Re-Transplantation Outcomes\",\"authors\":\"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\",\"doi\":\"10.1111/ctr.70124\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Heart 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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We 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/m<sup>2</sup>). The primary outcome was death or third re-HT.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>We 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 (<i>p</i> = 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; <i>p</i> = 0.026).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Among patients with severe CAV, those with RCP appear to have a worse prognosis after re-HT compared to those without RCP. 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Impact of Restrictive Cardiac Allograft Physiology on Heart Re-Transplantation Outcomes
Background
Heart 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.
Methods
We 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.
Results
We 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).
Conclusions
Among 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.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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