Abstract
BACKGROUND: Thromboembolism (TE) is a serious and potentially life-threatening complication following orthotopic heart transplant (OHT) that is not well described in current literature. OBJECTIVES: We aimed to characterize postoperative venous (VTE) and arterial thromboembolism (ATE) after OHT and describe their impact on survival. METHODS: We identified adult (aged ≥18 years) patients undergoing OHT from 2016 to 2022 in the TriNetX Research Network, which includes data from >140 million individuals from 102 institutions. Our primary outcomes were VTE or ATE within 30 days posttransplant and 1-year mortality. We used multivariable logistic regression to evaluate risk factors associated with TE and the association between TE and 1-year mortality. RESULTS: Among 2625 patients from 28 institutions who underwent OHT, the 30-day incidence of TE was 34% (VTE 27%, ATE 16%), and 1-year mortality was 6%. Patients experiencing TE were older (54 vs 52 years, P < .001) and more likely to have comorbidities (P < .05). Risk factors independently associated with VTE were history of hypertension, diabetes, and prior VTE; for ATE, history of diabetes, prior ATE, and prior VTE were significant (P < .05). Risk of 1-year mortality increased with VTE (odds ratio [OR] 1.43, P = .045) and ATE (OR 1.82, P = .002), but this association was not significant after adjusting for covariates (VTE: adjusted OR 0.97, P = .86; ATE: adjusted OR 1.39, P = .12). CONCLUSION: TE is common after OHT and may reflect underlying patient comorbidity, emphasizing the need for high clinical suspicion of TE post OHT to mitigate morbidity and mortality.