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Perioperative Risk Factors of Cardiac Allograft Vasculopathy in the Long-Term Follow-up
B Szyguła-Jurkiewicz1, M Zakliczyński2, W Szczurek3
13(rd) Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland, Silesian Center for Heart Diseases, Zabrze, Poland.
Insights
Cardiac allograft vasculopathy (CAV) is a major concern after heart transplants. Pre-transplant NT-proBNP, post-transplant fibrinogen levels, and diabetes are key predictors of CAV development, aiding early risk identification.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomarker Research
Background:
- Cardiac allograft vasculopathy (CAV) significantly limits long-term survival in heart transplant recipients.
- Identifying perioperative risk factors for CAV is crucial for improving patient outcomes.
Purpose of the Study:
- To identify perioperative risk factors associated with the development of cardiac allograft vasculopathy (CAV).
- To evaluate the predictive value of NT-proBNP and fibrinogen levels for CAV onset.
Main Methods:
- Retrospective analysis of 198 adult heart transplant recipients between 2007-2012.
- CAV onset defined by lesions observed in routine coronary angiography (CAG).
- Multivariate logistic regression and ROC curve analysis to identify predictors.
Main Results:
- The incidence of CAV was 18.1% over an average follow-up of 63.6 months.
- Pre-transplant NT-proBNP, post-transplant fibrinogen, and diabetes were independent predictors of CAV.
- Plasma fibrinogen (AUC 0.9278) and NT-proBNP (AUC 0.9514) showed strong discriminatory power for CAV prediction.
Conclusions:
- NT-proBNP and fibrinogen plasma concentrations, along with diabetes status, can identify heart transplant patients at risk for CAV.
- These biomarkers and clinical factors offer valuable tools for early CAV risk stratification.
Background:
Cardiac allograft vasculopathy (CAV) still remains to be one of the most important limiting factors for heart transplant recipients' long-term survival. The aim of our study was to identify the perioperative risk factors impacting the occurrence of CAV during the long-term follow-up.
Methods:
We retrospectively analysed the data from 198 consecutive adult patients, who underwent heart transplantation between 2007 and 2012, in whom at least one routine coronarography (CAG) was performed. CAV onset was defined as any lesion seen at least at one routine CAG.
Results:
The average follow-up was 63.6 ± 14.7 months. The frequency of CAV in the analysed population was 36 (18.1%). Multivariate stepwise logistic regression analysis confirmed that NT-proBNP plasma concentration directly before heart transplant [logNT-proBNP OR = 16.455 (4.587-31.036), P < .0001], fibrinogen plasma concentration a month after heart transplant [OR = 1.022 (1.009-1.035), P < .001] and occurrence of diabetes [OR = 12.355 (1.417-35.750), P < .001], were independent predictors of CAV. Area under the ROC curves (AUC) indicated a well discriminatory power of plasma fibrinogen [AUC 0.9278, P < .001] and plasma NTproBNP concentration [AUC 0.9514, P < .001] in CAV prediction. The optimal cut-off value of fibrinogen was 509 mg/dL, and of NT-proBNP was 10080 pg/mL.
Conclusions:
Our data show that NT-proBNP and fibrinogen plasma concentrations as well as occurence of diabetes, both preexisting and new onset after heart transplant can be used to identify patients at risk of developing CAV.
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