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

BACKGROUND: 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. METHODOLOGY: 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%. RESULTS: 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). CONCLUSION: 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.