title: Venous thromboembolism in heart transplant recipients: incidence, recurrence and predisposing factors.
abstract: BACKGROUND
  A high frequency of venous thromboembolism (VTE) has been observed after lung, kidney, and liver transplantation. However, data about the incidence of this complication among heart transplant (HT) recipients are lacking.
  
  
  METHODS
  We analyzed the incidence, recurrence, and predisposing factors of VTE in a single-center cohort of 635 patients who underwent HT from April 1991 to April 2013. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were considered as VTE episodes.
  
  
  RESULTS
  During a median post-transplant follow-up of 8.4 years, 62 VTE episodes occurred in 54 patients (8.5%). Incidence rates of VTE, DVT, and PE were, respectively, 12.7 (95% confidence interval [CI], 9.7-16.3), 8.4 (95% CI, 6.0-11.4), and 7.0 (95% CI 4.8-9.7) episodes per 1,000 patient-years. Incidence rates of VTE during the first post-transplant year and beyond were, respectively, 45.1 (95% CI, 28.9-67.1) and 8.7 (95% CI 6.2-11.2) episodes per 1,000 patient-years. The incidence rate of VTE recurrence after a first VTE episode was 30.5 (95% CI, 13.2-60.2) episodes per 1,000 patient-years. By means of multivariable Cox regression, chronic renal dysfunction, older age, obesity, and the use of mammalian target of rapamycin inhibitors were identified as independent risk factors for VTE among HT recipients.
  
  
  CONCLUSIONS
  VTE is a frequent complication after HT, mainly during the first post-operative year. In view of a high recurrence rate, long-term anti-coagulation should be considered in HT recipients who experience a first VTE episode.
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Fundación BBVA-Carolina, Madrid, Spain.
authors.forename: Rolando J
authors.initials: RJ
authors.lastname: Alvarez-Alvarez
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. Electronic address: eduardo.barge.caballero@sergas.es.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Fundación BBVA-Carolina, Madrid, Spain.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Chavez-Leal
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Paniagua-Martin
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Marzoa-Rivas
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Cayetana-Barbeito
authors.initials: CB
authors.lastname: Caamaño
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Ángela
authors.initials: Á
authors.lastname: López-Sainz
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Zulaika
authors.initials: Z
authors.lastname: Grille-Cancela
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Blanco-Canosa
authors.affiliation: Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Servicio de Cirugía Cardiaca. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Herrera-Noreña
authors.affiliation: Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Servicio de Cirugía Cardiaca. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: José J
authors.initials: JJ
authors.lastname: Cuenca-Castillo
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
authors.affiliation: Servicio de Cardiología. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: María G
authors.initials: MG
authors.lastname: Crespo-Leiro
mesh_terms: D001706:Biopsy; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
keywords: deep venous thrombosis; heart transplantation; pulmonary embolism; thromboembolism