Recovery Of Allograft Right Ventricular Diastolic Dysfunction Post Heart Transplantation

Abstract

Background Diastolic dysfunction after heart transplantation is a well-recognized phenomenon that is associated with high mortality. However, it is clinically well recognized that most allografts demonstrate stiffness in the early phase that recovers to a variable extent in most patients. The pattern of this recovery has not been well defined.ObjectivesWe aim to describe the natural course of allograft right ventricular (RV) diastolic function recovery in those without significant rejection or primary graft dysfunction events. Methods We retrospectively reviewed 22 patients who underwent orthotropic heart transplantation at UFhealth between September of 2015 and June of 2018. Exclusion criteria were significant acute cellular rejection (2R or more), primary graft dysfunction, and death due to any cause during the first year after transplantation. Invasive hemodynamics obtained during routine surveillance biopsies were recorded. We registered RV end diastolic and nadir pressures at 2 weeks, 1, 3, 6 and 12 months post-transplant. Results In our sample, the median age at transplant was 48 years, 63.6% were male, 4.6% were Hispanic, 72.3% were White, 22.7% were Black, 4.6% belonged to other racial groups. Looking at cardiovascular risk factors, 27.3% had diabetes, 90.9% had hypertension, and 18.2% had obesity with median BMI of 27. Figure 1 shows the trend of RV pressures overtime. Cold ischemic time was on average 211 min and did not correlate with RV end diastolic pressure (R = 0.49). Conclusions Early post transplantation period is associated with RV diastolic dysfunction that usually recovers by 12 weeks post operatively. Diastolic dysfunction after heart transplantation is a well-recognized phenomenon that is associated with high mortality. However, it is clinically well recognized that most allografts demonstrate stiffness in the early phase that recovers to a variable extent in most patients. The pattern of this recovery has not been well defined.ObjectivesWe aim to describe the natural course of allograft right ventricular (RV) diastolic function recovery in those without significant rejection or primary graft dysfunction events. We retrospectively reviewed 22 patients who underwent orthotropic heart transplantation at UFhealth between September of 2015 and June of 2018. Exclusion criteria were significant acute cellular rejection (2R or more), primary graft dysfunction, and death due to any cause during the first year after transplantation. Invasive hemodynamics obtained during routine surveillance biopsies were recorded. We registered RV end diastolic and nadir pressures at 2 weeks, 1, 3, 6 and 12 months post-transplant. In our sample, the median age at transplant was 48 years, 63.6% were male, 4.6% were Hispanic, 72.3% were White, 22.7% were Black, 4.6% belonged to other racial groups. Looking at cardiovascular risk factors, 27.3% had diabetes, 90.9% had hypertension, and 18.2% had obesity with median BMI of 27. Figure 1 shows the trend of RV pressures overtime. Cold ischemic time was on average 211 min and did not correlate with RV end diastolic pressure (R = 0.49). Early post transplantation period is associated with RV diastolic dysfunction that usually recovers by 12 weeks post operatively.