Neurocognitive outcomes and memory transfer in heart transplantation

Abstract

Introduction: Cardiac transplantation remains a life-saving intervention for end-stage cardiac disease, substantially improving survival and quality of life. While physiological and immunological challenges, such as graft rejection and immunosuppression, are well- characterized, emerging evidence underscores complex neurocognitive and psychological transformations in recipients. These include debated phenomena such as shifts in memory, behavior, and personality, which challenge conventional paradigms of transplantation outcomes.

Methodology: This scoping review was conducted by performing comprehensive literature searches of databases including PubMed, Scopus, Google Scholar, Cochrane Library, and PsycINFO using MeSH keywords: "heart transplant," "neurocognitive outcomes," "cellular memory," AND "personality transfer." The timeline spanned 1990 through June 2025.

Inclusion criteria: (1) peer-reviewed clinical studies; (2) case reports providing detailed narrative descriptions relevant to memory/personality changes; (3) manuscripts written in English; (4) reports including ≥5 participants/patients.

Exclusion criteria: (1) non-transplant cardiac studies; (2) animal research; (3) editorials/opinions/gray literature; (4) non-English manuscripts. Study quality was assessed through manual review of documented accounts alongside corresponding peer-reviewed manuscripts.

Results: This review synthesizes theories, case studies, and mechanistic hypotheses from published reports, exploring neurocognitive trajectories and purported memory-behavioral transfer between donors and recipients. Epigenetic modifications—such as DNA methylation and histone remodeling—are hypothesized to alter gene expression in donor-derived cells, potentially influencing recipient cognition and behavior. Concurrently, immune-brain crosstalk, mediated by cytokines and neuroinflammatory pathways, may exacerbate psychological distress, including identity dissonance and anxiety. Cognitive-behavioral interventions and psychosocial support emerge as critical tools for post-transplant adaptation.

Conclusion: Current evidence on memory transfer remains inconclusive, yet its implications for biological-psychological interconnectedness warrant rigorous interdisciplinary inquiry. By integrating neuroscientific, immunological, and psychological frameworks, future research can elucidate the mechanisms underlying post-transplant neurocognitive phenomena, optimizing therapeutic strategies and patient counseling.