A Comprehensive Retrospective Cohort Study on Heart Transplantation: Exploring Complications, Mortality Causes, and Survival Rates
-
Salma Nozhat
,
Mahmood Zamirian
,
Alireza Arzhangzade
,
Sasan Shafiei
,
Keivan Sahebi
,
Roozbeh Narimani Javid
,
Sarvenaz Salahi
,
Hassan Foroozand
,
Khalil Zarrabi
,
Masoud Shafiee
,
Hosein Fatemian
,
Ali Mohammad Keshtvarz Hesam Abadi
Abstract
Background: Heart transplantation (HTx) has become the preferred treatment for certain individuals with advanced heart failure. However, the outcomes and complications of this procedure have not been thoroughly evaluated in the Iranian population. In this study, we aimed to provide a comprehensive understanding of the epidemiological characteristics of patients who underwent HTx, focusing on the indications for HTx, early and late complications, causes of mortality, and survival rates.
Methods: In this retrospective cohort study, we included all patients aged 18 years and older who underwent HTx between July 2013 and June 2023 at Namazi Academic Hospital, affiliated with Shiraz University of Medical Sciences. We collected baseline and clinical characteristics and 10-year follow-up data from medical records. The 10-year survival data were presented using the Kaplan-Meier curve. Subgroup survival analyses based on Allograft rejection status, sex, and age were also performed.
Results: We identified 75 patients who underwent HTx during the study period, including 48 males and 27 females. The most prevalent underlying cause for HTx was dilated cardiomyopathy, accounting for 85.3% of the surgeries. After the procedure, 15 patients showed signs of allograft rejection. The survival analysis indicated a mean survival of 71.3 ± 6.5 months. The 1-, 5-, and 10-year survival rates were reported at 80%, 51%, and 42%, respectively.
Conclusions: Overall, this study’s findings offer valuable insights into the demographic and clinical characteristics of patients undergoing HTx and their outcomes. Additionally, our results enhance current knowledge regarding pre-HTx risk assessment and patient selection, early post-HTx diagnosis, and the management of significant complications.
1. Kim IC, Youn JC, Kobashigawa JA. The Past, Present, and Future of Heart Transplantation. Korean Circ J. 2018;48(7):565-90.
2. Javid RN, Hosseini SK. CT-derived Fractional Flow Reserve: How, When, and Where to Use This Novel Cardiac Imaging Tool. Current Cardiology Reviews. 2024;20(6).
3. Lund LH, Edwards LB, Kucheryavaya AY, Dipchand AI, Benden C, Christie JD, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Official Adult Heart Transplant Report--2013; focus theme: age. J Heart Lung Transplant. 2013;32(10):951-64.
4. Nikoo MH, Narimani-Javid R, Kamrava A, Shafiei S, Nozhat S, Fatemian H, et al. PR Interval as a Valuable Predictor of Tilt Table Test Results in Patients With Neurally Mediated Syncope. Annals of Noninvasive Electrocardiology. 2025; 30 (2): e70054.
5. Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Jr., Hsich E, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match. J Heart Lung Transplant. 2019;38(10):1056-66.
6. Lindenfeld J, Miller GG, Shakar SF, Zolty R, Lowes BD, Wolfel EE, et al. Drug therapy in the heart transplant recipient: Part II: immunosuppressive drugs. Circulation. 2004;110(25):3858-65.
7. Mangini S, Alves BR, Silvestre OM, Pires PV, Pires LJ, Curiati MN, Bacal F. Heart transplantation: review. Einstein (São Paulo). 2015;13(2):310-8.
8. Dantal J, Soulillou JP. Immunosuppressive drugs and the risk of cancer after organ transplantation. N Engl J Med. 2005;352(13):1371-3.
9. Engels EA, Pfeiffer RM, Fraumeni JF, Jr., Kasiske BL, Israni AK, Snyder JJ, et al. Spectrum of cancer risk among US solid organ transplant recipients. Jama. 2011;306(17):1891-901.
10. Arabyarmohammadi S, Yuan C, Viswanathan VS, Lal P, Feldman MD, Fu P, et al. Failing to Make the Grade: Conventional Cardiac Allograft Rejection Grading Criteria Are Inadequate for Predicting Rejection Severity. Circ Heart Fail. 2024;17(2):e010950.
11. Paghdar S, Desai S, Jang JM, Ruiz J, Malkani S, Patel P, et al. One-year survival in recipients older than 50 bridged to heart transplant with Impella 5.5 via axillary approach. J Geriatr Cardiol. 2023;20(5):319-29.
12. Forsberg A, Kisch AM, Paulsson A, Ragntoft C, Dalvindt M, Lennerling A. Fear of graft rejection after heart transplantation - a nationwide cross-sectional cohort study. Eur J Cardiovasc Nurs. 2021;20(1):71-9.
13. Kamath M, Shekhtman G, Grogan T, Hickey MJ, Silacheva I, Shah KS, et al. Variability in Donor-Derived Cell-Free DNA Scores to Predict Mortality in Heart Transplant Recipients - A Proof-of-Concept Study. Front Immunol. 2022;13:825108.
14. Rodrigues LFJ, Moreira BR, Duque AP, Oliveira JR, Figueiredo PHS, Oliveira CR, et al. Double Product and Autonomic Function as Predictors of Quality of Life in Heart Transplant Recipients: A Cross-Sectional Study. Braz J Cardiovasc Surg. 2022;37(4):454-65.
15. García-Cosío MD, González-Vilchez F, López-Vilella R, Barge-Caballero E, Gómez-Bueno M, Martínez-Selles M, et al. Gender differences in heart transplantation: Twenty-five-year trends in the nationwide Spanish heart transplant registry. Clin Transplant. 2020;34(12):e14096.
16. Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20(11):1505-35.
17. Narimani-Javid R, Moradi M, Mahalleh M, Najafi-vosough R, Arzhangzadeh A, Khalique O, et al. Machine learning and computational fluid dynamics-derived FFRCT demonstrate comparable diagnostic performance in patients with coronary artery disease; A Systematic Review and Meta-Analysis. Journal of Cardiovascular Computed Tomography. 2025.
18. Dalvindt M, Nozohoor S, Kisch A, Lennerling A, Forsberg A. Symptom Occurrence and Distress after Heart Transplantation-A Nationwide Cross-Sectional Cohort Study. Int J Environ Res Public Health. 2020;17(21).
19. Arzhangzade A, Zamirian M, Nozhat S, Shafei S, Narimani Javid R, Salahi S, Khorshidi S. Clinical case of Cor triatriatum sinister, a dilemma of anticoagulation: A case report and literature review. Clinical Case Reports. 2024;12(7):e8908.
20. Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant. 2017;36(10):1037-46.
21. Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33(4):327-40.
22. Brahmbhatt DH, Blitzer D, Billia F, Copeland H. Acute complications posttransplant: primary allograft dysfunction. Curr Opin Organ Transplant. 2023;28(5):376-83.
23. Anaraki KT, Zahed Z, Javid RN, Shafiei S, Beiranvandi F, Kahrizsangi NG, et al. Immune response following transcatheter aortic valve procedure. Vascular Pharmacology. 2024;154:107283.
24. Birati EY, Rame JE. Post-heart transplant complications. Crit Care Clin. 2014;30(3):629-37.
25. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29(8):914-56.
26. Wenke K, Meiser B, Thiery J, Nagel D, von Scheidt W, Krobot K, et al. Simvastatin initiated early after heart transplantation: 8-year prospective experience. Circulation. 2003;107(1):93-7.
27. Bae JH, Rihal CS, Edwards BS, Kushwaha SS, Mathew V, Prasad A, et al. Association of angiotensin-converting enzyme inhibitors and serum lipids with plaque regression in cardiac allograft vasculopathy. Transplantation. 2006;82(8):1108-11.
28. Schroeder JS, Gao SZ, Alderman EL, Hunt SA, Johnstone I, Boothroyd DB, et al. A preliminary study of diltiazem in the prevention of coronary artery disease in heart-transplant recipients. N Engl J Med. 1993;328(3):164-70.
29. Mancini D, Pinney S, Burkhoff D, LaManca J, Itescu S, Burke E, et al. Use of rapamycin slows the progression of cardiac transplantation vasculopathy. Circulation. 2003;108(1):48-53.
30. Alyaydin E, Sindermann JR, Köppe J, Gerss J, Dröge P, Ruhnke T, et al. Depression and Anxiety in Heart Transplant Recipients: Prevalence and Impact on Post-Transplant Outcomes. J Pers Med. 2023;13(5).
31. Kuczaj A, Pawlak S, Przybyłowski P, Warwas S, Śliwka JE, Zakliczyński M, Hrapkowicz T. Patient-Related Preoperative Clinical Factors Influencing 1-Year Survival After Orthotopic Heart Transplantation - A Single Center Polish Experience. Ann Transplant. 2022;27:e934185.
32. Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report--2014; focus theme: retransplantation. J Heart Lung Transplant. 2014;33(10):996-1008.
33. Deuse T, Haddad F, Pham M, Hunt S, Valantine H, Bates MJ, et al. Twenty-year survivors of heart transplantation at Stanford University. Am J Transplant. 2008;8(9):1769-74.
34. Ongcharit P, Wongkietkachorn K, Sritangsirikul S, Namchaisiri J, Singhatanatkit S, Luengtaviboon K, et al. Heart transplantation 1987--2007: 20 years' experience at Chulalongkorn hospital. Transplant Proc. 2008;40(8):2591-3.
35. González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Gómez-Bueno M, González-Costello J, Pérez-Villa F, et al. Spanish Heart Transplant Registry. 32nd Official Report of the Heart Failure Association of the Spanish Society of Cardiology. Rev Esp Cardiol (Engl Ed). 2021;74(11):962-70.
36. Gummert JF. Heart Transplantation in Bad Oeynhausen, Germany: The Heart Transplant program at the Heart and Diabetes Center Bad Oeynhausen, University Hospital, Ruhr-University Bochum, Germany. Eur Heart J. 2017;38(46):3411-3.
2. Javid RN, Hosseini SK. CT-derived Fractional Flow Reserve: How, When, and Where to Use This Novel Cardiac Imaging Tool. Current Cardiology Reviews. 2024;20(6).
3. Lund LH, Edwards LB, Kucheryavaya AY, Dipchand AI, Benden C, Christie JD, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Official Adult Heart Transplant Report--2013; focus theme: age. J Heart Lung Transplant. 2013;32(10):951-64.
4. Nikoo MH, Narimani-Javid R, Kamrava A, Shafiei S, Nozhat S, Fatemian H, et al. PR Interval as a Valuable Predictor of Tilt Table Test Results in Patients With Neurally Mediated Syncope. Annals of Noninvasive Electrocardiology. 2025; 30 (2): e70054.
5. Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Jr., Hsich E, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match. J Heart Lung Transplant. 2019;38(10):1056-66.
6. Lindenfeld J, Miller GG, Shakar SF, Zolty R, Lowes BD, Wolfel EE, et al. Drug therapy in the heart transplant recipient: Part II: immunosuppressive drugs. Circulation. 2004;110(25):3858-65.
7. Mangini S, Alves BR, Silvestre OM, Pires PV, Pires LJ, Curiati MN, Bacal F. Heart transplantation: review. Einstein (São Paulo). 2015;13(2):310-8.
8. Dantal J, Soulillou JP. Immunosuppressive drugs and the risk of cancer after organ transplantation. N Engl J Med. 2005;352(13):1371-3.
9. Engels EA, Pfeiffer RM, Fraumeni JF, Jr., Kasiske BL, Israni AK, Snyder JJ, et al. Spectrum of cancer risk among US solid organ transplant recipients. Jama. 2011;306(17):1891-901.
10. Arabyarmohammadi S, Yuan C, Viswanathan VS, Lal P, Feldman MD, Fu P, et al. Failing to Make the Grade: Conventional Cardiac Allograft Rejection Grading Criteria Are Inadequate for Predicting Rejection Severity. Circ Heart Fail. 2024;17(2):e010950.
11. Paghdar S, Desai S, Jang JM, Ruiz J, Malkani S, Patel P, et al. One-year survival in recipients older than 50 bridged to heart transplant with Impella 5.5 via axillary approach. J Geriatr Cardiol. 2023;20(5):319-29.
12. Forsberg A, Kisch AM, Paulsson A, Ragntoft C, Dalvindt M, Lennerling A. Fear of graft rejection after heart transplantation - a nationwide cross-sectional cohort study. Eur J Cardiovasc Nurs. 2021;20(1):71-9.
13. Kamath M, Shekhtman G, Grogan T, Hickey MJ, Silacheva I, Shah KS, et al. Variability in Donor-Derived Cell-Free DNA Scores to Predict Mortality in Heart Transplant Recipients - A Proof-of-Concept Study. Front Immunol. 2022;13:825108.
14. Rodrigues LFJ, Moreira BR, Duque AP, Oliveira JR, Figueiredo PHS, Oliveira CR, et al. Double Product and Autonomic Function as Predictors of Quality of Life in Heart Transplant Recipients: A Cross-Sectional Study. Braz J Cardiovasc Surg. 2022;37(4):454-65.
15. García-Cosío MD, González-Vilchez F, López-Vilella R, Barge-Caballero E, Gómez-Bueno M, Martínez-Selles M, et al. Gender differences in heart transplantation: Twenty-five-year trends in the nationwide Spanish heart transplant registry. Clin Transplant. 2020;34(12):e14096.
16. Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20(11):1505-35.
17. Narimani-Javid R, Moradi M, Mahalleh M, Najafi-vosough R, Arzhangzadeh A, Khalique O, et al. Machine learning and computational fluid dynamics-derived FFRCT demonstrate comparable diagnostic performance in patients with coronary artery disease; A Systematic Review and Meta-Analysis. Journal of Cardiovascular Computed Tomography. 2025.
18. Dalvindt M, Nozohoor S, Kisch A, Lennerling A, Forsberg A. Symptom Occurrence and Distress after Heart Transplantation-A Nationwide Cross-Sectional Cohort Study. Int J Environ Res Public Health. 2020;17(21).
19. Arzhangzade A, Zamirian M, Nozhat S, Shafei S, Narimani Javid R, Salahi S, Khorshidi S. Clinical case of Cor triatriatum sinister, a dilemma of anticoagulation: A case report and literature review. Clinical Case Reports. 2024;12(7):e8908.
20. Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant. 2017;36(10):1037-46.
21. Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33(4):327-40.
22. Brahmbhatt DH, Blitzer D, Billia F, Copeland H. Acute complications posttransplant: primary allograft dysfunction. Curr Opin Organ Transplant. 2023;28(5):376-83.
23. Anaraki KT, Zahed Z, Javid RN, Shafiei S, Beiranvandi F, Kahrizsangi NG, et al. Immune response following transcatheter aortic valve procedure. Vascular Pharmacology. 2024;154:107283.
24. Birati EY, Rame JE. Post-heart transplant complications. Crit Care Clin. 2014;30(3):629-37.
25. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29(8):914-56.
26. Wenke K, Meiser B, Thiery J, Nagel D, von Scheidt W, Krobot K, et al. Simvastatin initiated early after heart transplantation: 8-year prospective experience. Circulation. 2003;107(1):93-7.
27. Bae JH, Rihal CS, Edwards BS, Kushwaha SS, Mathew V, Prasad A, et al. Association of angiotensin-converting enzyme inhibitors and serum lipids with plaque regression in cardiac allograft vasculopathy. Transplantation. 2006;82(8):1108-11.
28. Schroeder JS, Gao SZ, Alderman EL, Hunt SA, Johnstone I, Boothroyd DB, et al. A preliminary study of diltiazem in the prevention of coronary artery disease in heart-transplant recipients. N Engl J Med. 1993;328(3):164-70.
29. Mancini D, Pinney S, Burkhoff D, LaManca J, Itescu S, Burke E, et al. Use of rapamycin slows the progression of cardiac transplantation vasculopathy. Circulation. 2003;108(1):48-53.
30. Alyaydin E, Sindermann JR, Köppe J, Gerss J, Dröge P, Ruhnke T, et al. Depression and Anxiety in Heart Transplant Recipients: Prevalence and Impact on Post-Transplant Outcomes. J Pers Med. 2023;13(5).
31. Kuczaj A, Pawlak S, Przybyłowski P, Warwas S, Śliwka JE, Zakliczyński M, Hrapkowicz T. Patient-Related Preoperative Clinical Factors Influencing 1-Year Survival After Orthotopic Heart Transplantation - A Single Center Polish Experience. Ann Transplant. 2022;27:e934185.
32. Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report--2014; focus theme: retransplantation. J Heart Lung Transplant. 2014;33(10):996-1008.
33. Deuse T, Haddad F, Pham M, Hunt S, Valantine H, Bates MJ, et al. Twenty-year survivors of heart transplantation at Stanford University. Am J Transplant. 2008;8(9):1769-74.
34. Ongcharit P, Wongkietkachorn K, Sritangsirikul S, Namchaisiri J, Singhatanatkit S, Luengtaviboon K, et al. Heart transplantation 1987--2007: 20 years' experience at Chulalongkorn hospital. Transplant Proc. 2008;40(8):2591-3.
35. González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Gómez-Bueno M, González-Costello J, Pérez-Villa F, et al. Spanish Heart Transplant Registry. 32nd Official Report of the Heart Failure Association of the Spanish Society of Cardiology. Rev Esp Cardiol (Engl Ed). 2021;74(11):962-70.
36. Gummert JF. Heart Transplantation in Bad Oeynhausen, Germany: The Heart Transplant program at the Heart and Diabetes Center Bad Oeynhausen, University Hospital, Ruhr-University Bochum, Germany. Eur Heart J. 2017;38(46):3411-3.
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| Issue | Vol 20 No 1 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v20i1.19216 | |
| Keywords | ||
| Heart Transplantation Patient Outcome Assessment Survival Rate | ||
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How to Cite
1.
Nozhat S, Zamirian M, Arzhangzade A, Shafiei S, Sahebi K, Narimani Javid R, Salahi S, Foroozand H, Zarrabi K, Shafiee M, Fatemian H, Keshtvarz Hesam Abadi AM. A Comprehensive Retrospective Cohort Study on Heart Transplantation: Exploring Complications, Mortality Causes, and Survival Rates. Res Heart Yield Transl Med. 2024;20(1):2-12.
