Work

Impact of Aspirin Use on Mortality and Cardiac Allograft Vasculopathy After Heart Transplantation: A Systematic Review and Meta‐analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: Cardiac allograft vasculopathy (CAV) remains a major cause of late graft failure and morbidity among heart transplant (HTx) recipients. Aspirin is currently assigned a Class IIb recommendation for CAV prevention, reflecting the limited evidence supporting its clinical benefit. We conducted a systematic review and meta-analysis to assess the association between aspirin use and clinical outcomes in HTx recipients (PROSPERO ID: CRD420261399873). METHODS: Outcomes of interest included all-cause mortality and CAV-related clinical outcomes (graft dysfunction or CAV-related death). Literature searches were conducted through December 2025 in PubMed and EMBASE. Studies comparing HTx recipients treated with aspirin versus no aspirin were included. Hazard ratios (HRs) and 95% confidence intervals (CIs) were meta-analyzed across studies. RESULTS: Five observational studies were included, comprising four adult cohorts and one pediatric cohort. Participants were predominantly male (66.6%), with a mean age of ≈50 years in the four adult studies and 7.4 years in the sole pediatric study. Aspirin use was associated with significantly lower all-cause mortality (four studies, HR 0.31 [95% CI: 0.15-0.67]). No statistically significant association was observed with CAV-related clinical outcomes (HR 0.42 [95% CI: 0.10-1.77]). CONCLUSIONS: In HTx recipients, aspirin use was associated with lower all-cause mortality, while no significant association was observed in the exploratory analysis of CAV-related clinical outcomes. These findings should be interpreted cautiously given the observational design, substantial heterogeneity, and potential residual and time-related biases. Prospective studies are needed to determine the efficacy and safety of aspirin after HTx.

Source: Clinical Transplantation

DOI: 10.1111/ctr.70742