{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:27:50Z","timestamp":1793831270197,"version":"4.6.1"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T00:00:00Z","timestamp":1703808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>(1) Background: Heart failure is an extremely impactful health issue from both a social and quality-of-life point of view and the rate of patients with this condition is destined to rise in the next few years. Transplantation remains the mainstay of treatment for end-stage heart failure, but a shortage of organs represents a significant problem that prolongs time spent on the waiting list. In view of this, the selection of donor and recipient must be extremely meticulous, considering all factors that could predispose to organ failure. One of the main considerations regarding heart transplants is the risk of graft rejection and the need for immunosuppression therapy to mitigate that risk. In this study, we aimed to assess the characteristics of patients who need immunosuppression treatment for rejection within one year of heart transplantation and its impact on mid-term and long-term mortality. (2) Methods: The United Network for Organ Sharing (UNOS) Registry was queried to identify patients who solely underwent a heart transplant in the US between 2000 and 2021. Patients were divided into two groups according to the need for anti-rejection treatment within one year of heart transplantation. Patients\u2019 characteristics in the two groups were assessed, and 1 year and 10 year mortality rates were compared. (3) Results: A total of 43,763 patients underwent isolated heart transplantation in the study period, and 9946 (22.7%) needed anti-rejection treatment in the first year. Patients who required treatment for rejection within one year after transplant were more frequently younger (49 \u00b1 14 vs. 52 \u00b1 14 years, p &lt; 0.001), women (31% vs. 23%, p &lt; 0.001), and had a higher CPRA value (14 \u00b1 26 vs. 11 \u00b1 23, p &lt; 0.001). Also, the rate of prior cardiac surgery was more than double in this group (27% vs. 12%, p &lt; 0.001), while prior LVAD (12% vs. 11%, p &lt; 0.001) and IABP (10% vs. 9%, p &lt; 0.01) were more frequent in patients who did not receive anti-rejection treatment in the first year. Finally, pre-transplantation creatinine was significantly higher in patients who did not need treatment for rejection in the first year (1.4 vs. 1.3, p &lt; 0.01). Most patients who did not require anti-rejection treatment underwent heart transplantation during the new allocation era, while less than half of the patients who required treatment underwent transplantation after the new allocation policy implementation (65% vs. 49%, p &lt; 0.001). Patients who needed rejection treatment in the first year had a higher risk of unadjusted 1 year (HR: 2.25; 95% CI: 1.88\u20132.70; p &lt; 0.001), 5 year (HR: 1.69; 95% CI: 1.60\u20131.79; p &lt; 0.001), and 10 year (HR: 1.47; 95% CI: 1.41\u20131.54, p &lt; 0.001) mortality, and this was confirmed at the adjusted analysis at all three time-points. (4) Conclusions: Medical treatment of acute rejection was associated with significantly increased 1 year mortality compared to patients who did not require anti-rejection therapy. The higher risk of mortality was confirmed at a 10 year follow-up. Further studies and newer follow-up data are required to investigate the role of anti-rejection therapy in the heart transplant population.<\/jats:p>","DOI":"10.3390\/jpm14010052","type":"journal-article","created":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T09:15:11Z","timestamp":1703841311000},"page":"52","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Rejection Requiring Treatment within the First Year following Heart Transplantation: The UNOS Insight"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2902-7947","authenticated-orcid":false,"given":"Marco","family":"Gemelli","sequence":"first","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padua, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias P.","family":"Doulamis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aspasia","family":"Tzani","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Rempakos","sequence":"additional","affiliation":[{"name":"Medical School of Athens, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polydoros","family":"Kampaktsis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University Irving Medical Center, New York City, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulino","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5495-6919","authenticated-orcid":false,"given":"Alvise","family":"Guariento","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padua, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Xanthopoulos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University General Hospital of Larissa, 413 34 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grigorios","family":"Giamouzis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University General Hospital of Larissa, 413 34 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4332-258X","authenticated-orcid":false,"given":"Kyriakos","family":"Spiliopoulos","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University of Thessaly, 412 23 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0258-7402","authenticated-orcid":false,"given":"Rabea","family":"Asleh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA"},{"name":"Heart Institute, Hadassah University Medical Center, Jerusalem 9112001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9777-4883","authenticated-orcid":false,"given":"Ernesto","family":"Ruiz Duque","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5740-9670","authenticated-orcid":false,"given":"Alexandros","family":"Briasoulis","sequence":"additional","affiliation":[{"name":"Medical School of Athens, National and Kapodistrian University of Athens, 157 72 Athens, Greece"},{"name":"Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.cardfail.2022.02.010","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure","volume":"28","author":"Heidenreich","year":"2022","journal-title":"J. Card. Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"l223","DOI":"10.1136\/bmj.l223","article-title":"Trends in survival after a diagnosis of heart failure in the United Kingdom 2000\u20132017: Population based cohort study","volume":"364","author":"Taylor","year":"2019","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.jchf.2020.01.014","article-title":"Advanced Heart Failure: Epidemiology, Diagnosis, and Therapeutic Approaches","volume":"8","author":"Truby","year":"2020","journal-title":"JACC Heart Fail."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.jchf.2017.02.020","article-title":"Progression to Stage D Heart Failure Among Outpatients with Stage C Heart Failure and Reduced Ejection Fraction","volume":"5","author":"Kalogeropoulos","year":"2017","journal-title":"JACC Heart Fail."},{"key":"ref_6","unstructured":"(2023, October 20). Thoracic Organ Transplantation Committee U: OPTN\/UNOS Policy Notice Proposal to Modify the Adult Heart Allocation SystemA (RRB and Committee Review of Exceptions) BEtA, Available online: https:\/\/optn.transplant.hrsa.gov\/media\/2006\/thoracic_brief_201612.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1001\/jamacardio.2020.4909","article-title":"Evolving Trends in Adult Heart Transplant with the 2018 Heart Allocation Policy Change","volume":"6","author":"Kilic","year":"2021","journal-title":"JAMA Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.healun.2022.10.015","article-title":"The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients","volume":"42","author":"Velleca","year":"2023","journal-title":"J. Heart Lung Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/j.healun.2023.05.008","article-title":"Effect of the UNOS policy change on rates of rejection, infection and hospital readmission following heart transplantation","volume":"42","author":"Vaidya","year":"2023","journal-title":"J. Heart Lung Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.healun.2019.08.004","article-title":"The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report\u20142019, focus theme: Donor and recipient size match","volume":"38","author":"Khush","year":"2019","journal-title":"J. Heart Lung Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.healun.2010.08.007","article-title":"The Registry of the International Society for Heart and Lung Transplantation: Twenty-seventh official adult heart transplant report\u20142010","volume":"29","author":"Stehlik","year":"2010","journal-title":"J. Heart Lung Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/S1053-2498(00)00460-5","article-title":"Determinants of early graft failure following cardiac transplantation, a 10-year, multi-institutional, multivariable analysis","volume":"20","author":"Young","year":"2001","journal-title":"J. Heart Lung Transplant."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e15114","DOI":"10.1111\/ctr.15114","article-title":"Impact of new allocation system on length of stay following heart transplantation in the United States","volume":"37","author":"Doulamis","year":"2023","journal-title":"Clin. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.healun.2015.08.003","article-title":"The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report--2015, Focus Theme: Early Graft Failure","volume":"34","author":"Lund","year":"2015","journal-title":"J. Heart Lung Transplant."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.healun.2023.03.005","article-title":"European multicenter study on the real-world use and clinical impact of extracorporeal photopheresis after heart transplantation","volume":"42","author":"Barten","year":"2023","journal-title":"J. Heart Lung Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/MOT.0000000000000641","article-title":"The meaning of donor-specific antibodies after heart transplant","volume":"24","author":"Barten","year":"2019","journal-title":"Curr. Opin. Organ. Transplant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/MOT.0000000000000636","article-title":"The clinical impact of donor-specific antibodies on antibody-mediated rejection and long-term prognosis after heart transplantation","volume":"24","author":"Su","year":"2019","journal-title":"Curr. Opin. Organ. Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.healun.2014.11.024","article-title":"Factors associated with anti-human leukocyte antigen antibodies in patients supported with continuous-flow devices and effect on probability of transplant and post-transplant outcomes","volume":"34","author":"Alba","year":"2015","journal-title":"J. Heart Lung Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1111\/ajt.14673","article-title":"Biologic mechanisms and clinical consequences of pregnancy alloimmunization","volume":"18","author":"Porrett","year":"2018","journal-title":"Am. J. Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1161\/01.CIR.91.4.1029","article-title":"Increased early mortality in women undergoing cardiac transplantation","volume":"91","author":"Wechsler","year":"1995","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1177\/1474515116651178","article-title":"Clinical and gender differences in heart transplant recipients in the NEW HEART study","volume":"16","author":"Hickey","year":"2017","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.healun.2016.08.008","article-title":"Association of recipient age and causes of heart transplant mortality: Implications for personalization of post-transplant management-An analysis of the International Society for Heart and Lung Transplantation Registry","volume":"36","author":"Edwards","year":"2017","journal-title":"J. Heart Lung Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1111\/tri.13481","article-title":"Donor and recipient age matching in heart transplantation: Analysis of the UNOS Registry","volume":"32","author":"Jawitz","year":"2019","journal-title":"Transpl. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1161\/CIRCHEARTFAILURE.108.844183","article-title":"The impact of donor-recipient sex matching on survival after orthotopic heart transplantation: Analysis of 18 000 transplants in the modern era","volume":"2","author":"Weiss","year":"2009","journal-title":"Circ. Heart Fail."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"617062","DOI":"10.3389\/fcvm.2021.617062","article-title":"Influence of Sex-Mismatch on Prognosis After Heart Transplantation","volume":"8","author":"Ayesta","year":"2021","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jchf.2013.09.005","article-title":"Cardiac size and sex-matching in heart transplantation : Size matters in matters of sex and the heart","volume":"2","author":"Reed","year":"2014","journal-title":"JACC Heart Fail."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e553","DOI":"10.1161\/CIR.0000000000000598","article-title":"Sensitization in Heart Transplantation: Emerging Knowledge: A Scientific Statement From the American Heart Association","volume":"139","author":"Colvin","year":"2019","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.healun.2013.08.014","article-title":"HLA and MICA allosensitization patterns among patients supported by ventricular assist devices","volume":"32","author":"Askar","year":"2013","journal-title":"J. Heart Lung Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.healun.2008.12.017","article-title":"Report from a consensus conference on the sensitized patient awaiting heart transplantation","volume":"28","author":"Kobashigawa","year":"2009","journal-title":"J. Heart Lung Transplant."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e1497","DOI":"10.1097\/TXD.0000000000001497","article-title":"HLA Sensitization in Patients Bridged to Lung Transplantation with Extracorporeal Membrane Oxygenation","volume":"9","author":"Goetz","year":"2023","journal-title":"Transplant. Direct."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s40635-019-0249-y","article-title":"Extracorporeal life support and systemic inflammation","volume":"7","author":"Pettenuzzo","year":"2019","journal-title":"Intensive Care Med. Exp."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/j.athoracsur.2017.03.066","article-title":"Optimal Timing of Heart Transplant After HeartMate II Left Ventricular Assist Device Implantation","volume":"104","author":"Steffen","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.xjon.2021.10.013","article-title":"The good, the bad, the ugly: Optimal left ventricular assist device duration in bridge to transplantation","volume":"8","author":"Goodwin","year":"2021","journal-title":"JTCVS Open."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.healun.2017.02.015","article-title":"Calculated panel-reactive antibody predicts outcomes on the heart transplant waiting list","volume":"36","author":"Kransdorf","year":"2017","journal-title":"J. Heart Lung Transplant."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/1\/52\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:44:16Z","timestamp":1760132656000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/1\/52"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,29]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jpm14010052"],"URL":"https:\/\/doi.org\/10.3390\/jpm14010052","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,29]]}}}