AUTHOR=Yavasca Ezgi , Rosenthal Lisa-Maria , Stegherr Regina , Wiebelt Levin , Just-Lauer Isabell , Kramer Peter , Danne Friederike , Schoenrath Felix , Konietschke Frank , Yigitbasi Mustafa , Berger Felix , Schmitt Katharina R. L. , Miera Oliver , Lunze Fatima I. 
  
TITLE=Elevated filling pressures are associated with poor long-term graft survival after pediatric heart transplantation
  
JOURNAL=Transplant International
  
VOLUME=Volume 39 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.16339
  
DOI=10.3389/ti.2026.16339
  
ISSN=1432-2277
  
ABSTRACT=Long-term survival has improved in the current era of pediatric heart transplantation (HT). The impact of elevated filling pressures [EFP; defined as pulmonary capillary wedge pressure (PCWP) > 15 mmHg and/or right atrial pressure (RAP) > 12 mmHg in the absence of biopsy-confirmed rejection] on long-term outcomes beyond 10 years remains poorly characterized. We assessed whether EFP during the early years after HT are associated with poor graft survival and cardiovascular adverse events (AE). We retrospectively analyzed 114 pediatric HT grafts (1986–2020) with available PCWP and/or RAP measurements 7 months to 5 years post-transplant (grouping period), representing a landmark cohort of 5-year survivors. Associations of EFP with graft survival and AE were evaluated. Fourteen grafts (12%) had EFP during the grouping period. Grafts with EFP had significantly worse long-term survival (44% vs. 85% at 10 years; log-rank p < 0.001), and higher risk of graft loss (overall HR 6.04, 95% CI [2.01–16.85]). The incidence of AE was numerically higher in grafts with EFP (26.6 [15.2–43.2] vs. 11.9 [9.4–14.9] per 100 person-years), but should be interpreted as exploratory. EFP within the early years post-transplant are associated with poor graft survival and may indicate cardiovascular complications.