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Published on: May 14, 2013
Angiographic, pathologic, and clinical relationships in coronary artery disease in cardiac allografts
Michel Haddad1, Peter W Pflugfelder, Collette Guiraudon
1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada.
Insights
Cardiac allograft coronary artery disease is a significant complication after heart transplantation. Both immune responses and traditional risk factors contribute to its development and progression over time.
Area of Science:
- Cardiology
- Transplantation Immunology
- Vascular Biology
Background:
- Etiology of allograft coronary disease remains speculative.
- Treatment for cardiac allograft vascular disease is uncertain.
- Long-term outcomes of heart transplant recipients are impacted by graft disease.
Purpose of the Study:
- Review clinical, angiographic, and pathologic features of cardiac allograft vascular disease.
- Identify factors associated with coronary artery disease in heart transplant recipients.
- Analyze a large cohort of patients followed for up to 15 years.
Main Methods:
- Reviewed 789 angiograms from 255 cardiac allografts (1981-1996).
- Analyzed demographic, clinical, and laboratory variables.
- Performed pathologic examination on explanted grafts.
Main Results:
- Severe donor coronary artery disease implicated in up to 10% of early graft failures.
- Prevalence of angiographic coronary artery disease increased ~10% every 2 years post-transplant.
- Older donor age and rejection episodes were key factors at 1 year; immune and traditional risk factors (hypercholesterolemia, hyperglycemia) play a role in later disease.
Conclusions:
- Cardiac allograft coronary artery disease significantly limits long-term cardiac transplant success.
- Immune processes and traditional coronary artery disease risk factors are implicated in disease development.
Background:
To date, the etiologic factors involved in the development of allograft coronary disease remain speculative and the treatment uncertain. The purpose of this study was to review the relationship of clinical, angiographic, and pathologic features of cardiac allograft vascular disease in a large population of heart transplant recipients followed for up to 15 years.
Methods:
From 1981 to 1996, 789 angiograms from 255 cardiac allografts were reviewed to determine the prevalence and severity of coronary artery disease. Demographic, clinical, and laboratory variables were analyzed to identify factors associated with the presence of angiographic coronary artery disease. In addition, pathologic examination was performed on many of the lost grafts.
Results:
Unsuspected severe donor coronary artery disease may be responsible for up to 10% of early graft failures. Angiographic coronary artery disease prevalence increased by approximately 10% with every 2-year interval after transplantation. Angiographic coronary artery disease consisted most often of minor luminal irregularities. Severe disease occurred in 12% of patients. At 1 year, the most significant factors associated with the presence of coronary artery disease were older donor age and the number of rejection episodes. Immunologic factors as well as traditional coronary risk factors such as hypercholesterolemia and hyperglycemia may play an important role in the genesis and progression of later-developing abnormalities.
Conclusions:
Cardiac allograft coronary artery disease is a major limiting factor to the long-term success of cardiac transplantation. Immune processes, as well as traditional coronary artery disease risk factors, appear to play a role in the development of this disease.
