High-urgency heart transplantation and outcome trade-offs: early post-transplant infection and mortality

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Abstract
To evaluate differences in post-transplant outcomes by pre-transplant urgency status, focusing on early post-transplant infection and its contribution to mortality. We retrospectively analyzed 801 adult heart transplant recipients enrolled in the Korea Organ Transplant Registry (April 2014–December 2021). Recipients were classified as Status 0 (highest urgency; n=287) and Status 1–3 (n=514). Outcomes included all–cause mortality, post-transplant infection, acute allograft rejection, and cardiac allograft vasculopathy up to 5 years. Mediation, landmark, and multivariable time-dependent Cox models assessed the impact and determinants of infection. During 5-year follow-up, 128 recipients (16.0%) died. Status 0 recipients had higher mortality than Status 1–3 recipients (28.0% vs. 13.5%; P 24 hours) remained the strongest predictor. Status 0 heart transplant recipients had higher mortality and early post-transplant infection risk than Status 1–3 recipients. Early infection, largely associated with greater clinical severity and prolonged mechanical ventilation, may explain the excess mortality in this high-urgency group.

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