Predisposing factors for late mortality in heart transplant patients

Abstract

Background: Because of the growing prevalence of terminal heart failure on the one hand and organ shortage on the other hand, an optimal care of heart transplant recipients based on the knowledge of potential risk factors not only early, but also in a long-term course after heart transplantation is of great importance. Therefore, the aim of the present study was to identify predisposing factors for late mortality in this patient collective. Methods: Data from long-term heart transplant patients collected during follow-up visits in the current center were retrospectively analyzed. Clinical, laboratory, including immune monitoring and apparative examination results were studied with regard to all-cause mortality. Results: 172 patients after heart transplantation (mean: 13.2 ± 6.4 years) were divided into two groups: survivors (n = 133) and non-survivors (n = 39). In comparison with survivors, non-survivors were characterized by significantly more pronounced renal insufficiency with more frequent dialysis, anemia and worse functional status. Additionally, non-survivors obtained hearts from relevantly more obese donors. In a multivariate Cox regression analysis the following parameters were shown to be independent risk factors for increased mortality: CD4 percentage < 42%, C-reactive protein ≥ 0.5 mg/dL, presence of rejections requiring therapies in the past, onset of cardiac allograft vasculopathy < 5 years following heart transplantation with no use of beta-blockers. Conclusions: Low CD4+ cell percentages, sustained inflammation, relevant organ rejections, early onset of transplant vasculopathy and no use of beta-blockers are risk factors for higher mortality in a long-term follow-up after heart transplantation.

Diltiazem as a cyclosporine A-sparing agent in heart transplantation: Benefits beyond dose reduction

“…CAV is common in long-term follow-up after OHT and may have prognostic implications. [ 13 , 14 ] In contrast to previous reports on the potential of DZ to reduce its progression in short-term follow-up, we found no association between DZ prescription and CAV prevalence. [ 5 ] However, CAV was diagnosed significantly earlier following transplantation in patients not receiving DZ.…”

“…Our observations indicate the potential beneficial effect of DZ in decelerating CAV development in OHT recipients, resulting in a delayed onset. [13] In line with previous studies reporting on the potential of DZ to reduce the hepatotoxicity and nephrotoxicity of CsA in kidney transplant recipients, patients from the DZ group had a significantly better renal function and less frequent ESRD at the last follow-up. [5,6] Additionally, as observed concerning CAV, ESRD was diagnosed in a more prolonged follow-up in patients on DZ, thus indicating the nephroprotective properties of CsA-sparing.…”

“…Our observations indicate the potential beneficial effect of DZ in decelerating CAV development in OHT recipients, resulting in a delayed onset. [ 13 ]…”

Clonal hematopoiesis confers an increased mortality risk in orthotopic heart transplant recipients

“…The cause of death in this study was related to allograft dysfunction, acute rejection episode, CAV, and septic shock. The mechanisms responsible for the observed high mortality rate remains unclear, yet previous work has shown that non‐survivors after OHT were more likely to present with sustained inflammation 29 . Nonetheless, patients with CH were older, and tended to have a higher frequency of hypertension, dyslipidemia and smoking that could have an impact in our results.…”

Implications of obesity across the heart failure continuum

“… 84 Because HF incidence continues to increase while organs remain in limited supply, optimal strategies for improving outcomes following HT are of utmost importance. Alyaydin et al 85 analyzed 172 HT patients for mean 13.2 years and analyzed their patients as survivors and non-survivors. It was found that non-survivors obtained hearts from more obese donors, which would suggest that non-survivors were more likely to be obese, as recipients and donors are often matched by body size to obtain an appropriately sized organ.…”