Graft failure is an unfortunate fact of transplant life. The graph illustrates the Kaplan-Meier survival curve depending on age at transplant. Average survival is best for infants at over 20 years and worse for adolescents at 12 years.
Death or retransplant is usually a consequence of coronary artery vascular disease (CAV) sometimes referred to as transplant coronary artery disease (TCAD) although may be caused by repeated rejection episodes. It manifests as chronic heart failure with either a dilated left ventricle (HFrEF physiology) or often with a restrictive pattern (HFpEF). Combined physiology patterns are common.
On presentation it is important to rule out reversible causes - e.g. acute rejection, myocarditis. Coronary angiography should be undertaken as discrete stenoses may be amenable to stenting although there is debate as to the effectiveness in preventing death or retransplantation.
Heart failure treatment is useful but re transplantation is the only definitive treatment.