Heart Transplantation in Patients With Systemic Sclerosis.

Overview

abstract

INTRODUCTION: Systemic sclerosis (SSc) is a multisystem disease, frequently leading to heart failure (HF). Heart transplant (HT) remains the definitive therapy for advanced HF, but HT outcomes in SSc patients remain poorly characterized. This study aims to report the outcomes of HT in patients with SSc. METHODS: A retrospective analysis of all HT recipients with SSc between 2007 and 2024 at two transplant centers. Baseline characteristics, index admission, and post HT outcomes were captured from the electronic medical record. Pathology of explants and allograft biopsies was read by a dedicated pathologist. RESULTS: Seven of 1153 patients who received HT had SSc. Six of these received HT alone, while one received a heart-lung transplant. Five (71%) were waitlist status 2 at the time of transplant. Median age was 52, and five patients (71%) were male. Pathologic examination of the seven patients' explanted native hearts showed that two (29%) had active inflammation, six (86%) had fibrosis, and four (57%) had vascular remodeling. With a median follow-up of 3.2 years (range: 1.0-18.2) post-HT, six patients (86%) had a preserved ejection fraction at last assessment, while one suffered graft failure due to acute cellular (ACR) and antibody-mediated rejection (AMR). Two patients (29%) developed 2R ACR (range: 0-1 months), and two (29%) developed AMR (range: 4-5 years). Post-HT, one patient developed gastroparesis due to SSc, and one required a renal transplant due to complications of immunosuppression. CONCLUSIONS: HT in SSc patients demonstrates good mid-term graft function despite an increased incidence of rejection, supporting feasibility in carefully selected candidates.