Abnormal invasive hemodynamics in heart transplant recipients: A single-center, retrospective study

doi:10.5500/wjt.v15.i3.101245

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Transplant. Sep 18, 2025; 15(3): 101245
Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.101245

Abnormal invasive hemodynamics in heart transplant recipients: A single-center, retrospective study

Navin Rajagopalan, Donna R Dennis, Kenneth Campbell, Julia Akhtarekhavari

Navin Rajagopalan, Donna R Dennis, Julia Akhtarekhavari, Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, United States

Kenneth Campbell, Department of Physiology, Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, United States

Author contributions: Rajagopalan N was responsible for study design and data analysis and primary role in writing the manuscript; Dennis DR and Akhtarekhavari J were responsible for study design and assisted with data acquisition; Campbell K was responsible for study design and statistical analysis; all authors contributed to the writing and editing of the manuscript, read and approved the final version of the manuscript to be published.

Institutional review board statement: Our retrospective analysis has been approved by the University of Kentucky’s Institutional Review Board. The title of the protocol that encompasses our research is titled: “Cardiovascular Outcomes Research and Education”. The Institutional Review Board at our institution governs the proper ethical conduct of research and all researchers agree to accept responsibility for the scientific and ethical conduct of the study.

Informed consent statement: Participants were not required to provide informed consent for this retrospective study. Data was de-identified and collected retrospectively for this cohort study.

Conflict-of-interest statement: Navin Rajagopalan has served as a consultant for Abbott Laboratories. The other authors have no conflicts of interest to report.

Data sharing statement: De-identified data can be requested and considered by the authors on a case-by-case basis.

Corresponding author: Navin Rajagopalan, MD, Professor, Department of Internal Medicine, University of Kentucky, 900 South Limestone Street, Lexington, KY 40536, United States. navin_rajagopalan@yahoo.com

Received: September 8, 2024
Revised: February 16, 2025
Accepted: February 21, 2025
Published online: September 18, 2025
Processing time: 221 Days and 14.7 Hours

Abstract

BACKGROUND

Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.

AIM

To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.

METHODS

Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed. Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded. Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.

RESULTS

Data were available for 260 patients and 224 patients at 1-year and 3-year post-transplant respectively. At 1-year, abnormal hemodynamic parameters were common with 24% patients having right atrial pressure (RAP) > 10 mmHg, 52% with mean pulmonary artery pressure > 20 mmHg, and 12% with pulmonary capillary wedge pressure (PCWP) > 18 mmHg. Similar abnormalities were noted at 3-year post-transplant. Recipient body mass index (BMI) demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis (P < 0.001 for both). Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.

CONCLUSION

Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.

Keywords: Heart transplantation; Right heart catheterization; Obesity; Heart failure; Hemodynamics

Core Tip: Our research demonstrates that abnormal invasive hemodynamics are commonly observed in heart transplant recipients at 1-year and 3-year post-transplantation. Obesity as reflected by body mass index was strongly associated with elevated right atrial, mean pulmonary artery, and pulmonary capillary wedge pressure in transplant recipients. Further research is needed to determine if the development of abnormal hemodynamics predicts transplant mortality and if behavioral modifications and pharmacologic therapy can reverse observed hemodynamic abnormalities.