Natural History of Hemodynamic Maturation Post Heart Transplantation in the Absence of Rejection

Purpose Routine catheterization is a part of transplant surveillance, however there is extremely limited data on evolution of hemodynamic parameters post heart transplant. Knowledge of these normative data will be useful in interpretation of individual catheterization results, assessment of graft performance and identification of risk factors. Methods Prospectively collected transplant and hemodynamic data for patients enrolled in the Quantitative Detection of Circulating Donor-Specific DNA in Organ Transplant Recipients (DTRT Study) was secondarily analyzed. Results A total of 265 patients were included in the analysis. The patient population was representative for heart transplant population, with majority being White (64%), male (59%), listed as IA (61.4%) with dilated cardiomyopathy (31 % of cardiomyopathy group) or Hypoplastic left heart syndrome (43.8% of CHD group) as the common diagnosis. 83 (31%) were supported with LVAD at the time of transplantation. 8.5% of the transplants were performed in ABO incompatible group. Serial changes in hemodynamics in the absence of rejection are shown in figure 1. RAP and PCWP were significant predictors of outcomes. An RAP of g 10 mmHg and PCWP of g 15 mmHg at first available catheterization were significantly associated with mortality at 6 months, 1 and 2 years post-transplant (p=0.001). Mean survival for RAP was associated with overall mortality at one year post transplant in a cox proportional hazard model (p=0.012) while other recipient factors were not. Pairwise comparison and survival curves for elevated pressures are shown in figure 1. Conclusion This is the first, large scale, prospectively collected data on the hemodynamic evolution post-transplant in the absence of rejection. RAP greater than 10 mmHg and PCWP pressure greater than 15mmHg are significant markers of early graft loss and mortality and may warrant increased monitoring and modified treatment strategies.