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Reduced incidence of cardiac rejection in multi-organ transplants: A propensity matched study

Jonathan B Edelson1,2, Xuemei Zhang3, Andrew B Goldstone4

  • 1Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Clinical Transplantation
|May 22, 2023
PubMed

Insights

Multi-organ transplants, specifically heart-kidney and heart-liver, significantly reduce the risk of cardiac rejection compared to isolated heart transplants. However, one-year survival rates remain comparable for these combined procedures.

Area of Science:

  • Transplantation immunology
  • Cardiovascular surgery
  • Organ transplant outcomes

Background:

  • Graft rejection is a major challenge in heart transplantation (HT).
  • Understanding multi-organ transplant immunomodulation can clarify cardiac rejection mechanisms.

Purpose of the Study:

  • To compare the risk of rejection and mortality in patients undergoing isolated heart transplants versus combined heart-kidney, heart-liver, or heart-lung transplants.
  • To investigate the impact of combined organ transplantation on early post-transplant outcomes.

Main Methods:

  • Retrospective cohort study using the UNOS database (2004-2019).
  • Included patients with isolated heart (H), heart-kidney (HKi), heart-liver (HLi), and heart-lung (HLu) transplants.
  • Propensity score matching was used to control for baseline differences; outcomes included rejection and mortality within one year.

Main Results:

  • Heart-kidney and heart-liver recipients had significantly lower risks of rejection before discharge and within one year post-transplant compared to isolated heart recipients.
  • One-year mortality risk was similar for heart-kidney and heart-liver recipients compared to isolated heart recipients.
  • Heart-lung recipients showed a higher risk of one-year mortality.

Conclusions:

  • Combined heart-kidney and heart-liver transplantation is associated with a reduced risk of cardiac rejection.
  • These findings suggest potential benefits of combined organ transplantation in managing rejection post-heart transplant.
  • Further research into multi-organ transplant immunomodulation is warranted for advancing HT medicine.
Abstract

Keywords:
heart transplantmortality/survivalmulti-organ transplantrejection

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