Abstract Background Hospitalizations after successful heart transplantation (HT) are common and can occur for several reasons. However, there is limited data regarding their leading causes, timing and potential prognostic impact. Methods We conducted a single-center retrospective study of patients who underwent HT between 2018 and 2024, and survived to discharge. Patients with subsequent hospitalizations were characterized with respect to cause of admission, associated immunosuppression (IS), and total number of days spent in hospital. Additionally, the association between hospitalizations and all-cause mortality was evaluated and stratified according to the time elapsed since HT. Results The study population comprised 70 HT recipients (mean age 51±11 years; 33% women). During the median follow-up of 646 days IQR 327–1412, 10 patients died (14.3%). Overall, 31 patients (44%) were hospitalized at least once during follow-up (17 patients had ≥2 hospitalizations; maximum 8 hospitalizations per patient). Median time from HT to first hospitalization was 109 days IQR 27-464. Median length-of-stay was 16 days IQR 9–52. The first hospitalization occurred in the first year post-HT in 21 patients. Infections were the leading cause of hospitalization in this group (62%) - Figure 1, and 46% of these infections were linked to supratherapeutic IS. Rejection accounted for 24% of the remaining hospitalizations, and 40% of these were linked to subtherapeutic IS. Other causes of hospitalization included IS toxicity (9%). In-hospital mortality for the first hospitalization in the first year post-HT was 2.9%. The first hospitalization occurred after the first year post-HT in 10 patients. The cause of these admissions was infection in 30% of cases, of which 50% were linked to supratherapeutic IS. IS toxicity was the cause of another 20% of hospitalizations after the first year post-HT. No cases of acute allograft rejection were reported. In-hospital mortality for hospitalizations beyond the first year post-HT was 0%. All-cause mortality was higher among patients hospitalized within the first year post-HT compared with those without any hospitalization during follow up HR 5.49; 95%CI 1.42-21.27, p=0.014 - Figure 2. Patients with a first hospitalization after the first year post-HT had similar mortality compared with those without any hospitalization. Infection-related hospitalizations any time after HT were also associated with higher all-cause mortality HR 5.43; 95%CI 1.40-21.04; p=0.014 - Figure 3. Other causes of hospitalization did not impact subsequent survival. Conclusions Infections are a major cause of hospitalization post-HT, particularly in the first year, and are associated with higher all-cause mortality. These results underscore the delicate balance between IS and infectious risk, highlighting the need for optimized post-HT care strategies.
Presume et al. (Sat,) studied this question.