Preoperative Indicators of Graft Rejection in Patients With Heart Transplantation: A Single-Center Retrospective Study

TL;DR

This study explores factors linked to heart transplant outcomes, focusing on differences between ischemic and nonischemic patients and their risk of graft rejection.

Contribution

The study identifies associations between nonischemic cardiomyopathy, HLA-A variants, and graft rejection in heart transplant patients.

Findings

Nonischemic patients were more likely to experience the Quilty effect and graft rejection.

HLA-A variant expression was associated with graft rejection and the Quilty effect.

Ischemic patients had higher mean age, weight, BMI, and body surface area.

Abstract

Introduction: Heart failure (HF) represents a syndrome characterized by the heart’s inability to fulfill its pump role due to a decrease in its mechanical function or abnormal filling pressures. This disease is one of the focus areas in modern research, with medication and mechanical assistance devices being constantly developed. The final treatment option, when all the medical and device therapies have been exhausted, is represented by the heart transplant. Patients undergoing heart transplant face biological and psychological challenges, which must be addressed by attending physicians to increase the survival and quality of life of these individuals. The aim of this study was to describe the population who received a heart transplant in our center over 12 years and to assess potential connections between the etiology of cardiomyopathy associated with end-stage HF of the organ recipient and clinical and paraclinical outcomes.

Methods: We collected data for the patients who underwent a cardiac transplant in our center between 2011 and 2023, forming an initial cohort of 51 patients. Seven patients were excluded for incomplete data sheets, resulting in a final cohort of 44 patients. Means and medians were compared between the ischemic and nonischemic groups, and associations were investigated for each group with hospitalization parameters and clinical and histopathological outcomes.

Results: We found that the patients in the ischemic group had a higher mean age, weight, body mass index, and body surface area, while the nonischemic group has been associated with the development of the Quilty effect and graft rejection. Furthermore, the expression of the human leukocyte antigen-A variant was associated with graft rejection and Quilty effect.

Conclusion: Identifying factors that may predict or contribute to postoperative success is of utmost importance. Further studies are required to validate these results.

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