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Heart transplant coronary artery disease in Chinese recipients
K C Lee1, C Y Chang, Y C Chuang
1Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan. ch9066@chgh.org.tw
Insights
Chinese heart transplant recipients have a lower incidence of transplant coronary artery disease and better survival rates compared to Western patients. This may be due to factors like lower ischemia time and fewer rejection episodes.
Area of Science:
- Cardiology
- Transplantation immunology
Background:
- Transplant coronary artery disease (CAD) is a major limitation for long-term survival after heart transplantation (HTx).
- Assessing CAD incidence in Chinese HTx recipients is crucial for understanding long-term outcomes.
Purpose of the Study:
- To evaluate the incidence of transplant CAD in Chinese HTx recipients.
- To compare outcomes with Western studies.
Main Methods:
- Retrospective review of 184 orthotopic HTx cases (1988-2002).
- Analysis of 163 recipients with SPECT scans or coronary angiograms.
- Inclusion of donor/recipient characteristics, CMV infection, rejection episodes, and HLA mismatches.
Main Results:
- Actuarial freedom from CAD at 1, 3, and 5 years was 99%, 95%, and 92%.
- Older donor age was significant for CAD development.
- Chinese recipients showed higher survival and CAD-free rates than Western cohorts, with differences in ischemia time, gender, ischemic heart disease, rejection, and CMV infection.
Conclusions:
- SPECT scan effectively detects early transplant CAD.
- Chinese HTx recipients exhibit lower transplant CAD incidence, potentially due to reduced ischemia time, CMV infection, and rejection episodes, contributing to better survival.
Background:
Transplant coronary artery disease is the principle limiting factor for long-term survival of heart transplantation (HTx) recipients. We reviewed our data to assess the incidence of this disorder among Chinese HTx recipients and to compare it with the results of Western studies.
Material And Methods:
From July 1988 to May 2002, 182 patients received 184 orthotopic HTx. One hundred sixty-three recipients survived for at least 1 year with available SPECT scans or coronary angiogram studies. The data set included donor characteristics, recipient characteristics, active cytomegalovirus (CMV) infection rate, rejection episodes, immunosuppressants, and human leukocyte antigen (HLA) mismatches.
Results:
Surgical mortality in our program was 4.3% and the actuarial freedom from coronary artery disease at 1, 3, and 5 years was 99%, 95%, and 92%, respectively. Angiogram results were stratified into coronary artery disease (n = 15) or absence of the disorder (n = 148) groups. Only older donor age showed statistical significance between the groups. Compared with the Western series, the present data show higher actuarial survival rates and freedom from coronary artery disease. There were statistically significant differences in regard to graft ischemia time, proportion of male recipients, ischemic heart disease, rejection episodes during the first year, and incidence of CMV infection.
Conclusions:
SPECT scan can detect coronary artery disease before there is significant stenosis of the coronary artery with acceptable survival rates. Chinese HTx recipients show a lower incidence of the disorder, lower rates of ischemia heart disease, lower proportion of male gender, lower incidence of CMV infection, fewer rejection episodes during the first year, and less ischemic time than Western recipients, which maybe the contributing factors to their better survival.
