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Late complications of heart transplantation: an 11-year experience
S Esposito1, A Renzulli, L Agozzino
1Institute of Pathology, Second University of Naples, Italy.
Insights
Late heart transplant complications like cancer and infections significantly impact survival. Cytomegalovirus (CMV) and Hepatitis C virus (HCV) infections are strongly linked to allograft coronary artery disease (ACAD), a major cause of late mortality.
Area of Science:
- Cardiology
- Transplantation Medicine
- Infectious Diseases
Background:
- Heart transplantation survival has improved due to advances in donor/recipient selection and postoperative care.
- Late complications remain the primary cause of mortality following cardiac transplantation.
- Understanding these late complications is crucial for improving long-term patient outcomes.
Purpose of the Study:
- To identify and analyze the most frequent late complications after heart transplantation.
- To investigate the causes of late mortality in heart transplant recipients.
- To explore potential correlations between viral infections and late complications, particularly allograft coronary artery disease (ACAD).
Main Methods:
- Retrospective review of pathological specimens (endomyocardial biopsies, autopsies, explanted hearts) from 145 heart transplant patients with at least 6 months follow-up.
- Analysis of actuarial survival rates from January 1988 to March 1999 for 200 heart transplants and 2 retransplants.
- Serological testing for cytomegalovirus (CMV) and hepatitis C virus (HCV) in patients with allograft coronary artery disease (ACAD).
Main Results:
- The most frequent late complications were malignancies (9 patients), allograft coronary artery disease (ACAD) (6 patients), and infections (6 patients).
- Sudden death (38.46%), infections (23.08%), ACAD (15.38%), and cancer (15.38%) were the primary causes of late mortality.
- All patients with ACAD showed evidence of CMV infection, and 83.3% were positive for HCV infection, indicating a strong correlation.
Conclusions:
- Late mortality causes in heart transplant recipients differ significantly from early mortality.
- The development of infections, ACAD, and cancer are associated with a high rate of late mortality.
- Cytomegalovirus (CMV) and Hepatitis C virus (HCV) positivity are strongly correlated with ACAD, suggesting a role in the pathogenesis of vascular complications in transplanted hearts.
Abstract:
Advances in donor and recipient selection and postoperative management of patients undergoing a heart transplant have improved survival after cardiac transplantation; nevertheless, late complications are still the main cause of mortality. Between January 1988 and March 1999, 200 heart transplants and 2 retransplants were performed at our Institution. The actuarial survival rate was 84.45% at 1 month, 75.22% at 1 year, and 69.48% at 5 years. One-hundred forty-five patients reached at least 6 months of follow-up. In this group of patients we reviewed all available pathological specimens from endomyocardial biopsies, autopsies, and hearts retrieved at retransplantation. The most frequent late complications have been: malignancies (9 patients), allograft coronary artery disease (ACAD) (6 patients), and infections (6 patients). All patients with ACAD had serological evidence of cytomegalovirus (CMV) infection and 5 of them (83.3%) of hepatitis C virus (HCV) infection. Squamous cell lung carcinoma and Kaposi's sarcoma were the most frequent neoplasms (3 patients). Twenty-six out of 145 patients died during the follow-up: sudden death occurred in 10 patients (38.46%), infections caused death in 6 patients (23.08%). ACAD in 4, and cancer in 4. Causes and rates of late mortality in patients with a cardiac transplant differ from those of early mortality. Development of infections, ACAD, or cancer is associated with a high late mortality rate. A striking correlation has been found between ACAD and HCV and/or CMV positivity. suggesting that such viruses may play a role in the development of vascular late complications in transplanted hearts.