Prognostic implications of one-year left ventricular systolic function after heart transplantation

The role of donor left ventricular ejection fraction (LVEF) at heart procurement has been extensively studied. However, there remain scarce data on how 1-year post-heart transplant (HTx) LVEF affects recipient outcomes. Our study seeks to address this gap.

The OPTN database was analyzed for adult orthotopic HTx recipients between 2010-2022. Patients with missing LVEF data during their 1-year follow-up were excluded. Recipients were stratified into four groups based on their 1-year LVEF: preserved: ≥ 50%, mildly reduced: 40-49%, moderately reduced: 30-39%, and severely reduced: < 30%.

In total, 23,629 recipients were included in this analysis. Patients with a reduced 1-year LVEF had higher hospitalization rates, as well as acute graft rejection and renal failure necessitating dialysis in the postoperative and subacute period. There was an incremental increase in all-cause mortality as LVEF decreased: mildly reduced (HR = 1.28, p = 0.011), moderately reduced (HR = 1.90, p < 0.001), and severely reduced (HR = 2.06, p = 0.002). Cardiovascular-related mortality had parallel findings. Similarly, recipients with a reduced 1-year LVEF had a progressive increase in their CAV risk: mildly reduced (sHR = 1.28, p = 0.005), moderately reduced (sHR = 1.57, p = 0.004), and severely reduced (sHR = 1.65, p = 0.025).

Recipients with mild, moderate, and severe reductions in 1-year LVEF had higher rates of hospitalization, renal failure, and acute rejection, as well as a significant increase in mortality and CAV risk independent of other clinically relevant variables. The clinical implications of our findings suggest that LVEF 1-year after HTx is a powerful prognostic indicator that can allow clinicians to identify high-risk recipients, screen for comorbidities, and treat or manage subsequent pathologic processes timely.