Prevalence of donor-transmitted coronary artery disease and its influence on heart transplant outcomes.

Abstract

BACKGROUND It is uncertain whether donor-transmitted coronary artery disease (DTCAD) affects heart transplant (HT) recipients. METHODS This retrospective analysis includes records of all patients who underwent a HT at our center over an 8-year period, who survived for at least 1 month, and who were examined by coronary angiography within 2 months post-HT. We distinguished angiographically from keep ultrasonography (IVUS) detected DTCAD. Major adverse cardiovascular events (MACE) comprised death, myocardial infarction, unstable angina, coronary revascularization, and admission because of heart failure not due to an acute rejection episode. RESULTS Among the 171 patients of mean age 53±13 years and including 83% men, 65 (38%) were evaluated by IVUS. Donors were aged 40±14 years (range=14-73). Angiographic DTCAD affected seven patients (4.1%), and IVUS-detected DTCAD, 35 (53.8% of those examined by IVUS). DTCAD donors were older than non-DTCAD donors, by an average of 13 years (P=.001) for angiographic DTCAD and 18 years (P<.0001) for IVUS-detected DTCAD. Two patients underwent percutaneous revascularization upon detection of angiographic DTCAD. The angiographic- and IVUS-detected DTCAD groups did not differ significantly from the corresponding non-DTCAD groups as regards MACE incidence during 54±41 and 38±20 months follow-up, respectively. Cox regression analysis with adjustment for relevant confounders confirmed that IVUS-detected DTCAD was not a predictor of MACE (hazard ratio 1.2, 95% confidence interval 0.2-8.1). CONCLUSIONS Among HT patients surviving≥1 month, angiographic- and IVUS-detected DTCAD showed prevalences of <10% and >50%, respectively. Neither detection method was associated with a greater long-term incidence of MACE.

DOI: 10.1016/j.transproceed.2010.07.088

Cite this paper

@article{EstvezLoureiro2010PrevalenceOD, title={Prevalence of donor-transmitted coronary artery disease and its influence on heart transplant outcomes.}, author={Rodrigo Est{\'e}vez-Loureiro and Mar{\'i}a Jes{\'u}s Paniagua-Mart{\'i}n and Ram{\'o}n Antonio Calvi{\~n}o-Santos and Jos{\'e} Manuel V{\'a}zquez-Rodr{\'i}guez and Jorge Salgado-Fern{\'a}ndez and Raquel Marzoa-Rivas and Eduardo Barge-Caballero and Zulaika Grill{\'e} and Alejandro P{\'e}rez-P{\'e}rez and Jairo Armando Rodr{\'i}guez-Fern{\'a}ndez and Nicol{\'a}s V{\'a}zquez-Gonz{\'a}lez and Jos{\'e} Joaqu{\'i}n Cuenca-Castillo and Alfonso Castro-Beiras and Mar{\'i}a Generosa Crespo-Leiro}, journal={Transplantation proceedings}, year={2010}, volume={42 8}, pages={2987-91} }