Impact of Aspirin Use on Mortality and Cardiac Allograft Vasculopathy After Heart Transplantation: A Systematic Review and Meta-analysis.
5 affiliations
- 1Division of Cardiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.
- 2Division of Cardiac Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.
- 3Division of Cardiology, Geneva University Hospitals (HUG), University of Geneva (UNIGE), Geneva, Switzerland.
- 4Division of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- 5Department of Adult Intensive Care Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
Abstract
Cardiac allograft vasculopathy (CAV) remains a major cause of late graft failure and morbidity among heart transplant (HTx) recipients. Aspirin is currently assigned a Class IIb recommendation for CAV prevention, reflecting the limited evidence supporting its clinical benefit. We conducted a systematic review and meta-analysis to assess the association between aspirin use and clinical outcomes in HTx recipients (PROSPERO ID: CRD420261399873). Outcomes of interest included all-cause mortality and CAV-related clinical outcomes (graft dysfunction or CAV-related death). Literature searches were conducted through December 2025 in PubMed and EMBASE. Studies comparing HTx recipients treated with aspirin versus no aspirin were included. Hazard ratios (HRs) and 95% confidence intervals (CIs) were meta-analyzed across studies. Five observational studies were included, comprising four adult cohorts and one pediatric cohort. Participants were predominantly male (66.6%), with a mean age of ≈50 years in the four adult studies and 7.4 years in the sole pediatric study. Aspirin use was associated with significantly lower all-cause mortality (four studies, HR 0.31 [95% CI: 0.15-0.67]). No statistically significant association was observed with CAV-related clinical outcomes (HR 0.42 [95% CI: 0.10-1.77]). In HTx recipients, aspirin use was associated with lower all-cause mortality, while no significant association was observed in the exploratory analysis of CAV-related clinical outcomes. These findings should be interpreted cautiously given the observational design, substantial heterogeneity, and potential residual and time-related biases. Prospective studies are needed to determine the efficacy and safety of aspirin after HTx.
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BibTeX
@article{fournier2026impact,
title = {{Impact of Aspirin Use on Mortality and Cardiac Allograft Vasculopathy After Heart Transplantation: A Systematic Review and Meta-analysis.}},
author = {Noémie Fournier and Panagiotis Antiochos and Baris Gencer and Anna Nowacka and Tamila Abdurashidova and Patrick Yerly and Philippe Meyer and Valentina Rancati and Zied Ltaief and Olivier Muller and Matthias Kirsch and Roger Hullin and Henri Lu},
journal = {Clinical transplantation},
year = {2026},
month = nov,
doi = {10.1111/ctr.70742},
url = {https://europepmc.org/article/MED/42998260},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of Aspirin Use on Mortality and Cardiac Allograft Vasculopathy After Heart Transplantation: A Systematic Review and Meta-analysis.
AU - Noémie Fournier
AU - Panagiotis Antiochos
AU - Baris Gencer
AU - Anna Nowacka
AU - Tamila Abdurashidova
AU - Patrick Yerly
AU - Philippe Meyer
AU - Valentina Rancati
AU - Zied Ltaief
AU - Olivier Muller
AU - Matthias Kirsch
AU - Roger Hullin
AU - Henri Lu
PY - 2026
DA - 2026/11/01
JO - Clinical transplantation
DO - 10.1111/ctr.70742
UR - https://europepmc.org/article/MED/42998260
AB - Cardiac allograft vasculopathy (CAV) remains a major cause of late graft failure and morbidity among heart transplant (HTx) recipients. Aspirin is currently assigned a Class IIb recommendation for CAV prevention, reflecting the limited evidence supporting its clinical benefit. We conducted a systematic review and meta-analysis to assess the association between aspirin use and clinical outcomes in HTx recipients (PROSPERO ID: CRD420261399873). Outcomes of interest included all-cause mortality and CAV-related clinical outcomes (graft dysfunction or CAV-related death). Literature searches were conducted through December 2025 in PubMed and EMBASE. Studies comparing HTx recipients treated with aspirin versus no aspirin were included. Hazard ratios (HRs) and 95% confidence intervals (CIs) were meta-analyzed across studies. Five observational studies were included, comprising four adult cohorts and one pediatric cohort. Participants were predominantly male (66.6%), with a mean age of ≈50 years in the four adult studies and 7.4 years in the sole pediatric study. Aspirin use was associated with significantly lower all-cause mortality (four studies, HR 0.31 [95% CI: 0.15-0.67]). No statistically significant association was observed with CAV-related clinical outcomes (HR 0.42 [95% CI: 0.10-1.77]). In HTx recipients, aspirin use was associated with lower all-cause mortality, while no significant association was observed in the exploratory analysis of CAV-related clinical outcomes. These findings should be interpreted cautiously given the observational design, substantial heterogeneity, and potential residual and time-related biases. Prospective studies are needed to determine the efficacy and safety of aspirin after HTx.
SN - 0902-0063
SN - 1399-0012
ER -