Prevalence of Donor-Transmitted Coronary Artery Disease and Its Influence on Heart Transplant Outcomes

• Published in: Transplantation proceedings 2010-10, Vol.42 (8), p.2987-2991
• Main Authors: Estevez-Loureiro, R, Paniagua-Martin, M.J, Calviño-Santos, R, Vazquez-Rodríguez, J.M, Salgado-Fernandez, J, Marzoa-Rivas, R, Barge-Caballero, E, Grille, Z, Pérez-Pérez, A, Rodríguez-Fernandez, J.A, Vázquez-González, N, Cuenca-Castillo, J.J, Castro-Beiras, A, Crespo-Leiro, M.G
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Echocardiography; Epidemiology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Heart Transplantation; Humans; Male; Medical sciences; Middle Aged; Prevalence; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Donors; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.07.088

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 50%, respectively. Neither detection method was associated with a greater long-term incidence of MACE.