Determinants of graft arteriosclerosis after heart transplantation

Accelerated graft coronary artery disease (TxCAD) is now the most common complication limiting long-term survival after heart transplantation. This study examines its association with several potentially causative factors. The study population comprised all 73 transplants recipients at this centre between May 1985 and June 1989 who survived at least 2 years. Coronary angiography was performed in every patient at 2 years after transplantation and annually thereafter. All angiograms were retrospectively examined for any evidence of TxCAD. The number of rejection episodes and history of cytomegalovirus (CMV) infection were determined from patient records. Fasting serum triglycerides, and total and HDL cholesterol were measured at between 18 and 60 months after transplantation. Patients with advanced TxCAD (> 70% stenoses) had a mean of 1.4 +/- 1.4 rejection episodes in the first year compared with 0.5 +/- 0.8 episodes in those without TxCAD (P < 0.05). The mean number of episodes in all patients with any evidence of TxCAD was 0.8 +/- 1.1 which was not significantly different from those without TxCAD. There were no association between exposure to CMV infection and TxCAD or between hyperlipidaemia and TxCAD. We conclude that frequent episodes of allograft rejection are associated with the development of advanced TxCAD. Hyperlipidaemia is not associated with the development of TxCAD in the first 5 years after transplantation. A history of exposure to CMV is not associated with TxCAD in our patients possibly because of our routine use of anti-CMV hyperimmune globulin in CMV-mismatched patients.