Predictors and outcomes of rejection requiring treatment within the first year following heart transplantation

Abstract

Abstract Background Heart transplant remains the mainstay of treatment for end stage heart failure not controllable with maximum pharmacotherapy or surgical interventions. One of the main considerations regarding heart transplant is the risk for graft rejection and the need for immunosuppression therapy to mitigate that risk. Purpose To assess the impact of the need for immunosuppression for rejection treatment within one year for heart transplantation on mortality. Secondary objectives include risk factors for the need for anti-rejection treatment. Methods The United Network for Organ Sharing (UNOS) Registry was queried to identify patients who solely underwent heart transplant in the US between 2000 and 2021. Patients were divided into two groups according to the need for antirejection treatment within one year from heart transplantation. Results Patient demographics are summarized in Figure 1. Patients who required treatment for rejection within one year after transplant were younger (49±14 vs 52±14 years, p<0.001) and had higher CPRA value (14±26 vs 11±23, p<0.001) than patients who did not require treatment. Moreover, the majority of the patients who did not require antirejection treatment underwent heart transplantation during the new allocation era, while less than half of the patients who required treatment underwent transplant after the new allocation policy implementation (65% vs 49%, p<0.001). The latter group had higher risk for 10-year mortality (HR: 1.34; 95% CI: 1.29, 1.39, p<0.001; Figure 2), although no difference was noted at the 1-year timepoint. Conclusions Although medical treatment of acute rejection was associated with similar 1-year mortality with patients who did not require antirejection therapy, 10-year mortality was higher in this patient population. Further studies and newer follow up data are required to investigate the role of antirejection therapy in the heart transplant population.Figure 1Figure 2