Protective Effects of Combined Heart Transplantation on Cardiac Allograft Vasculopathy: A Systematic Review and Meta-Analysis

J. Maning, V. Blumer, S. Chaparro

Research output: Contribution to journalArticlepeer-review


PURPOSE: Despite significant advances in the field of heart transplantation, cardiac allograft vasculopathy (CAV) continues to be a major limitation of long-term survival. Previous studies have suggested that compared with isolated heart transplant (HTx) recipients, those who receive multiorgan heart transplants (HTxC) have superior clinical outcomes. We conducted a systematic review and meta-analysis to investigate the effects of combined organ transplantation on the incidence of CAV. METHODS: We searched Medline, Embase, and the Cochrane Library for studies evaluating outcomes after combined heart transplantation, in particular the incidence of CAV. We identified 1207 potential eligible publications. Outcomes were compared using the random-effects model and heterogenicity examined via X2 and I2 statistics. RESULTS: Six retrospective studies were included in our analysis for a total of 1383 heart transplant recipients. Of these, 190 (16%) underwent HTxC: 50 heart-kidney transplant (HKTx), 103 heart-lung transplant (HLTx), and 37 heart-liver transplant (HLvTx). Multiorgan heart transplantation was associated with less incidence of CAV (OR 0.19; 95% CI 0.07-0.51; p = 0.0009) and acute cardiac rejection (OR 0.18; 95% CI 0.07-0.47; p = 0.0005). Survival at 1 year was not significantly different among HTxC and HTx recipients (OR 0.68, 95% CI 0.42-1.10; p = 0.12). CONCLUSION: Multiorgan heart transplantation appears to be associated with a protective effect against CAV and acute cardiac rejection. Short term survival after combined heart transplant is comparable to isolated heart transplantation.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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