B133 - Heartbreaker: Takotsubo Cardiomyopathy After Solid Organ Transplantation

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Author Block: K. J. Swanson¹, J. Kim¹, V. Manchala², S. Parajuli¹, F. Aziz¹, ¹University of Wisconsin, Madison, WI, ²Medicine-Transplant Nephrology, University of Arkansas for Medical Sciences, Little Rock, AR
*Purpose: Minimal data exist describing the incidence, management, and long-term outcomes after Takotsubo cardiomyopathy (TCM) in solid organ transplant recipients (SOTRs).
*Methods: Single-center, observational study of patients who received a solid organ transplant between 1/1/2001-11/20/2025 and developed TCM at any time point after transplantation. Baseline characteristics and clinical outcomes were examined.
*Results: During the 24-year study period, 19 patients had documented TCM. Eleven patients (58%) were recipients of a liver transplant alone, four (21%) had a kidney transplant alone, two had simultaneous liver and kidney transplants (11%), and two had simultaneous pancreas and kidney transplants (11%). The mean age at the time of transplant was 57.9 ± 8.5 years. Fifteen patients (79%) received induction with basiliximab, and four patients (21%) received induction with anti-thymocyte globulin. Time from the transplant to the diagnosis of TCM was 42 ± 83 days. Fifteen (79%) of TCM cases occurred within 30 days of transplantation. Eighteen (95%) had no evidence of left ventricular systolic dysfunction before the transplant (mean ejection fraction 61% ± 0.5). All the patients presented with volume overload. Eight patients (42%) had troponin elevation, and six (32%) of the patients had ST-segment elevation. Two patients (11%) underwent coronary angiogram with no evidence of coronary artery disease. Eight patients (42%) received beta-blockers, and three patients (16%) received a combination of beta-blockers and angiotensin receptor blockers, while seven patients (37%) received none of these agents. All the patients required diuretics for volume management. The cardiac function of all the patients returned to baseline in 1.09 ± 2.5 years after TCM diagnosis. The mean follow-up after the diagnosis of TCM was 5.9 ± 5.0 years. At the last follow-up, no patients had death-censored graft failure and 9 patients had died. None of the deaths were directly attributable to a cardiac etiology.
*Conclusions: TCM after solid organ transplant is rare, though occurred more frequently in liver transplant recipients. There is noted variability of TCM timing, though appears to occur more commonly within 30 days post-transplant. TCM was not associated with graft loss or death within one year, with or without treatment with guideline-directed medical therapy for heart failure, after the diagnosis of TCM. TCM is an important potential differential diagnosis in the early post-SOT recipient experiencing volume overload.