The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026
Cardiogenic shock in heart transplant recipients: A multicenter cohort study with matched analysis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Harba Chahem, David-Papadopoulos Alexis, Frering Anouk, Lebreton Guillaume, Guendouz Soulef, Varnous Shaida, Chommeloux Juliette, Pineton de Chambrun Marc, Hékimian Guillaume, Luyt Charles-Edouard, Guihaire Julien, Sonneville Romain, Combes Alain, Schmidt Matthieu, Moyon Quentin, CASTER Investigator Group
Аннотация
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.
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.