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Elevated C-reactive protein (CRP) before heart transplantation (HTX) indicates a higher risk of death, especially from infections. Monitoring pre-transplant CRP levels can help identify patients needing closer follow-up for better post-transplant outcomes.

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Area of Science:

  • Cardiology
  • Transplantation Immunology
  • Biochemistry

Background:

  • Heart transplant recipients require lifelong immunosuppression, increasing infection risk.
  • C-reactive protein (CRP) is a marker of inflammation and infection severity.
  • The prognostic value of elevated pre-transplant CRP (≥20 mg/L) for heart transplantation outcomes was previously unclear.

Purpose of the Study:

  • To investigate the impact of elevated pre-transplant C-reactive protein (CRP) levels on post-heart transplantation (HTX) outcomes.
  • To determine if pre-transplant CRP ≥20 mg/L is an independent predictor of mortality after HTX.

Main Methods:

  • Retrospective, observational, single-center study of 418 heart transplant recipients (2000-2019).
  • Patients were grouped based on pre-transplant CRP levels (<20 mg/L vs. ≥20 mg/L).
  • Analysis included donor/recipient characteristics, pharmacotherapy, and post-transplant mortality, including causes of death.

Main Results:

  • 24.4% of patients had pre-transplant CRP ≥20 mg/L.
  • Elevated pre-transplant CRP was associated with significantly higher 30-day, 1-year, 2-year, and 5-year mortality.
  • Infection/sepsis, particularly pulmonary infections, was a more frequent cause of death within five years for patients with higher CRP levels.
  • Pre-transplant CRP ≥20 mg/L was an independent predictor of 5-year post-transplant mortality (HR: 1.630).

Conclusions:

  • Pre-transplant CRP ≥20 mg/L identifies heart transplant candidates at increased risk of infection-related mortality.
  • Pulmonary infections are a significant concern for these high-risk patients.
  • Intensified pre-transplant infection screening and close post-transplant infectious surveillance are recommended for patients with elevated CRP.