Post-operative multi-organ dysfunction following heart transplantation and left ventricular assist device implantation: phenotypes, trajectories, and prognostic implications-a retrospective study.
- 1Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- 2Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Abstract
Multi-organ dysfunction syndrome (MODS) is a leading cause of mortality after heart transplantation (HTx) and left ventricular assist device (LVAD), yet its phenotypic heterogeneity remains poorly characterised. This study intends to identify and clinically validate distinct multi-organ dysfunction phenotypes following HTx and LVAD implantation, and to analyse their early prognosis using longitudinal biomarker trajectories and independent clinical adjudication. This single-center retrospective study included 68 consecutive adult patients who underwent HTx or LVAD implantation in the Cardiothoracic and Vascular Surgery Department of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2020 and June 2025. The Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology approved this with a waiver of informed consent. We collected demographic, preoperative, and operative data from medical records. Postoperative MODS was defined by Sequential Organ Failure Assessment (SOFA) criteria as dysfunction with ≥2 organ systems. Patients were followed up for inpatient, 1-, and 2-year mortality. MODS occurred in 48 of 68 patients (70.6%). It was more frequent after HTx than LVAD (77.6% vs. 52.6%, P=0.08). The most common organ dysfunctions were cardiovascular (70.6%), hepatic (60.3%), and respiratory (50.0%). Patients with MODS had significantly longer cardiopulmonary bypass (CPB) duration than those without MODS (183.11±57.42 vs. 138.28±29.83 min; P=0.003) and higher rates of respiratory (68.8% vs. 5.0%; P<0.001), cardiovascular (83.3% vs. 40.0%; P=0.001), and renal dysfunction (50.0% vs. 5.0%; P=0.001). After adjustment, MODS was independently associated with 2-year mortality [hazard ratio (HR) =5.47, 95% confidence interval (CI): 1.07-27.9; P=0.04]. Latent class analysis (LCA) identified 2 MODS phenotypes: a high-severity/multi-system phenotype with high probabilities of renal (100%), hepatic (78%), and respiratory (72%) dysfunction, and a lower-severity/selective phenotype. The high-severity phenotype had significantly worse 2-year survival than the lower-severity phenotype (44.8% vs. 74.4%; log-rank P=0.005). With regard to post-cardiac surgery MODS, we report a novel trajectory-based approach that holds promise for improving early risk stratification and guiding targeted management by distinguishing high-severity multisystem from low-severity selective trajectories following HTx and LVAD implantation.
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BibTeX
@article{akilu2026postoperative,
title = {{Post-operative multi-organ dysfunction following heart transplantation and left ventricular assist device implantation: phenotypes, trajectories, and prognostic implications-a retrospective study.}},
author = {Wajeehullahi Akilu and Xin Feng and Phatcharaphan Pienpanichkul and Neen Laoniyomthai and Sarah Denise Francia Dubois and Xiang Wei and Xingyu Wang},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1983},
url = {https://europepmc.org/article/MED/42996667},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Post-operative multi-organ dysfunction following heart transplantation and left ventricular assist device implantation: phenotypes, trajectories, and prognostic implications-a retrospective study.
AU - Wajeehullahi Akilu
AU - Xin Feng
AU - Phatcharaphan Pienpanichkul
AU - Neen Laoniyomthai
AU - Sarah Denise Francia Dubois
AU - Xiang Wei
AU - Xingyu Wang
PY - 2026
DA - 2026/09/28
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1983
UR - https://europepmc.org/article/MED/42996667
AB - Multi-organ dysfunction syndrome (MODS) is a leading cause of mortality after heart transplantation (HTx) and left ventricular assist device (LVAD), yet its phenotypic heterogeneity remains poorly characterised. This study intends to identify and clinically validate distinct multi-organ dysfunction phenotypes following HTx and LVAD implantation, and to analyse their early prognosis using longitudinal biomarker trajectories and independent clinical adjudication. This single-center retrospective study included 68 consecutive adult patients who underwent HTx or LVAD implantation in the Cardiothoracic and Vascular Surgery Department of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2020 and June 2025. The Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology approved this with a waiver of informed consent. We collected demographic, preoperative, and operative data from medical records. Postoperative MODS was defined by Sequential Organ Failure Assessment (SOFA) criteria as dysfunction with ≥2 organ systems. Patients were followed up for inpatient, 1-, and 2-year mortality. MODS occurred in 48 of 68 patients (70.6%). It was more frequent after HTx than LVAD (77.6% vs. 52.6%, P=0.08). The most common organ dysfunctions were cardiovascular (70.6%), hepatic (60.3%), and respiratory (50.0%). Patients with MODS had significantly longer cardiopulmonary bypass (CPB) duration than those without MODS (183.11±57.42 vs. 138.28±29.83 min; P=0.003) and higher rates of respiratory (68.8% vs. 5.0%; P<0.001), cardiovascular (83.3% vs. 40.0%; P=0.001), and renal dysfunction (50.0% vs. 5.0%; P=0.001). After adjustment, MODS was independently associated with 2-year mortality [hazard ratio (HR) =5.47, 95% confidence interval (CI): 1.07-27.9; P=0.04]. Latent class analysis (LCA) identified 2 MODS phenotypes: a high-severity/multi-system phenotype with high probabilities of renal (100%), hepatic (78%), and respiratory (72%) dysfunction, and a lower-severity/selective phenotype. The high-severity phenotype had significantly worse 2-year survival than the lower-severity phenotype (44.8% vs. 74.4%; log-rank P=0.005). With regard to post-cardiac surgery MODS, we report a novel trajectory-based approach that holds promise for improving early risk stratification and guiding targeted management by distinguishing high-severity multisystem from low-severity selective trajectories following HTx and LVAD implantation.
SN - 2072-1439
SN - 2077-6624
ER -