Related Experiment Video
Updated: Jun 30, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Cardiogenic shock in heart transplant recipients: A multicenter cohort study with matched analysis
Chahem Harba1, Alexis David-Papadopoulos2, Anouk Frering3
1Department of Intensive Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.
Insights
Heart transplant recipients with graft failure-related cardiogenic shock (CS) face poor prognoses, with only 25% surviving one year event-free. Key survival predictors include allograft vasculopathy and need for renal replacement therapy.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) in heart transplant recipients (HTR) presents unique challenges.
- Graft failure is a significant cause of CS post-transplantation.
- Outcomes for HTR with CS are not well-defined compared to other CS etiologies.
Purpose of the Study:
- To evaluate the prognosis of HTR experiencing graft failure-related CS.
- To identify predictors of one-year event-free survival in these patients.
- To compare the outcomes of HTR with CS to patients with CS from other causes.
Main Methods:
- Retrospective multicenter study of HTR with CS (≥1 month post-transplant).
- Primary endpoint: one-year survival without retransplantation or long-term support.
- Propensity score matching compared HTR on VA-ECMO to AMICS and other immunocompromised CS patients.
Main Results:
- Cardiac allograft rejection (51%) and coronary allograft vasculopathy (19%) were primary CS causes in HTR.
- One-year event-free survival was 25%.
- Predictors of poor survival included CAV grade ≥2, renal replacement therapy, advanced SCAI stage, and ECMO during CPR. HTR on VA-ECMO had lower 90-day survival than AMICS patients (22% vs 55%).
Conclusions:
- CS post-heart transplantation is associated with a grave prognosis, with low one-year event-free survival.
- Outcomes for HTR with CS requiring VA-ECMO were worse than for AMICS patients.
- Survival for HTR with CS was comparable to other immunocompromised patients requiring similar support.
Background:
This study aimed to evaluate the prognosis of heart transplant recipients (HTR) with graft failure-related cardiogenic shock (CS), identify predictors of 1-year event-free survival, and compare their outcomes to those of patients with other CS etiologies.
Methods:
This retrospective multicenter study included all HTR admitted to the ICU between June 2006 and August 2024 for CS occurring ≥ 1 month after transplantation. The primary endpoint was 1-year survival, without retransplantation or long-term circulatory support. HTR receiving VA-ECMO were compared with propensity score matching to 2 external ECMO control cohorts: (1) patients with CS due to acute myocardial infarction (AMICS); and (2) immunocompromised patients with CS from various causes.
Results:
Among the 145 HTR included, the primary causes of shock were cardiac allograft rejection (51%), coronary allograft vasculopathy (19%), and other causes (30%), with no significant differences in survival across etiologies. Event-free survival was 25% at one year. Independent predictors of 1-year event-free survival included CAV grade ≥2 (HR 2.4; 95% CI, 1.6-3.7), renal replacement therapy at ICU admission (HR 1.9; 95% CI, 1.2-3.1), SCAI stage of cardiogenic shock ≥ D (HR 3.6; 95% CI 2.1 to 6.3), and ECMO initiated on cardiopulmonary resuscitation (HR 2.5; 95% CI, 1.5-4.1). In a matched analysis of VA-ECMO patients, heart transplant recipients had significantly lower 90-day survival than matched AMICS patients (22% vs 55%), whereas survival was not significantly different when compared with other immunocompromised non-transplant patients (28% vs 42%).
Conclusion:
CS occurring after heart transplantation is associated with very poor outcomes, with only one quarter of patients free from death, retransplantation, or durable mechanical circulatory support at 1 year. While prognosis appeared worse than in matched patients with AMICS requiring VA-ECMO, outcomes did not significantly differ from those of other immunocompromised patients receiving the same support.
More Related Videos
08:49Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
08:15Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:28Kidney Transplant I: Introduction