Takotsubo Syndrome in Solid Organ Transplant Recipients: Current Evidence, Clinical Challenges, and Future Perspectives—A Narrative Review

Takotsubo syndrome (TTS) is an acute and usually reversible form of myocardial dysfunction associated with emotional or physical stress. Solid organ transplantation (SOT) combines several potential triggers, including major surgical stress, hemodynamic instability, systemic inflammation, and exposure to exogenous catecholamines. Respiratory failure, calcineurin inhibitor toxicity, and altered cardiac innervation may also contribute. This narrative review summarizes current evidence on organ-specific timing, potential triggers, diagnostic challenges, management, and outcomes of TTS in SOT recipients. Reported cases predominantly occur early after liver and kidney transplantation, whereas presentations after heart transplantation range from the immediate postoperative period to years later. After heart transplantation, distinguishing TTS from early graft dysfunction and considering donor-side TTS are particularly important. Diagnostic certainty varies among published cases because formal criteria and the exclusion of competing diagnoses are inconsistently documented. Management largely follows recommendations for the general TTS population, with temporary mechanical circulatory support used in selected severe cases. Although ventricular function usually recovers, cardiogenic shock, arrhythmias, and multiorgan dysfunction may complicate the acute course, and persistent ventricular impairment has been associated with poorer long-term outcomes after liver transplantation. Comparisons with the general TTS population suggest a high proportion of severe presentations among reported transplant-associated cases; however, publication and ascertainment bias preclude firm conclusions about differences in incidence or severity. Evidence remains dominated by case reports, small series, and retrospective studies, underscoring the need for standardized reporting and prospective multicenter research.