Reduced incidence of cardiac rejection in multi-organ transplants: A propensity matched study

Clin Transplant. 2023 Sep;37(9):e15019. doi: 10.1111/ctr.15019. Epub 2023 May 22.

Abstract

Background: Rejection remains a primary cause of graft loss after heart transplant (HT). Recognizing the immunomodulation of multi-organ transplant can enhance our understanding of the mechanisms of cardiac rejection.

Methods: This retrospective cohort study identified patients from the UNOS database with isolated heart (H, N = 37 433), heart-kidney (HKi, N = 1516), heart-liver (HLi, N = 286), and heart-lung (HLu, N = 408) transplants from 2004 to 2019. Propensity score matching reduced baseline differences between groups. Outcomes included risk of rejection prior to transplant hospital discharge and within 1 year, and mortality within 1 year of transplant.

Results: In the propensity score matched data, the relative risk of being treated for rejection prior to transplant hospital discharge was 61% lower for HKi (RR .39, 95% CI .29, .53) and 87% lower for HLi (RR .13, 95% CI .05, .37) compared to H. Similarly, the probability of being treated for rejection in the first year after transplant remained lower in HKi (RR .45, 95% CI .35, .57) and HLi (RR .13, 95% CI .06, .28) compared to H. The 1-year survival analysis revealed an equivalent risk of death in HKi (HR .84, 95% CI .68, 1.03) and HLi (HR 1.41, 95% CI .83, 2.41) compared to H, while HLu had a higher risk of death in the first year after transplant (HR 1.65, 95% CI 1.17, 2.33).

Conclusions: Recipients of HKi and HLi experience a reduced risk of rejection when compared to H, but an equivalent risk of 1 yr mortality. These findings have important implications for the future of HT medicine.

Keywords: heart transplant; mortality/survival; multi-organ transplant; rejection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Graft Rejection* / epidemiology
  • Graft Rejection* / etiology
  • Graft Survival
  • Heart Transplantation* / adverse effects
  • Humans
  • Incidence
  • Retrospective Studies
  • Survival Analysis