Neurocognitive outcomes and memory transfer in heart transplantation

Cardiac transplantation remains a life-saving intervention for end-stage cardiac disease, substantially improving survival and quality of life. While physiological and immunological challenges, such as graft rejection and immunosuppression, are well-characterized, emerging evidence underscores complex neurocognitive and psychological transformations in recipients. These include debated phenomena such as shifts in memory, behavior, and personality, which challenge conventional paradigms of transplantation outcomes.

This scoping review was conducted by performing comprehensive literature searches of databases including PubMed, Scopus, Google Scholar, Cochrane Library, and PsycINFO using MeSH keywords: "heart transplant", "neurocognitive outcomes", "cellular memory", AND "personality transfer". The timeline spanned 1990 through June 2025.

(1) peer-reviewed clinical studies; (2) case reports providing detailed narrative descriptions relevant to memory/personality changes; (3) manuscripts written in English; (4) reports including ≥5 participants/patients.

(1) non-transplant cardiac studies; (2) animal research; (3) editorials/opinions/gray literature; (4) non-English manuscripts. Study quality was assessed through manual review of documented accounts alongside corresponding peer-reviewed manuscripts.

This review synthesizes theories, case studies, and mechanistic hypotheses from published reports, exploring neurocognitive trajectories and purported memory-behavioral transfer between donors and recipients. Epigenetic modifications-such as DNA methylation and histone remodeling-are hypothesized to alter gene expression in donor-derived cells, potentially influencing recipient cognition and behavior. Concurrently, immune-brain crosstalk, mediated by cytokines and neuroinflammatory pathways, may exacerbate psychological distress, including identity dissonance and anxiety. Cognitive-behavioral interventions and psychosocial support emerge as critical tools for post-transplant adaptation.

Current evidence on memory transfer remains inconclusive, yet its implications for biological-psychological interconnectedness warrant rigorous interdisciplinary inquiry. By integrating neuroscientific, immunological, and psychological frameworks, future research can elucidate the mechanisms underlying post-transplant neurocognitive phenomena, optimizing therapeutic strategies and patient counseling.