Related Experiment Video
Updated: Mar 15, 2026
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Cardiac allograft vasculopathy in Dutch heart transplant recipients
G Galli1,2, K Caliskan1, A H M M Balk1
1Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Insights
Cardiac allograft vasculopathy (CAV) prevalence increases over time after heart transplantation. Early CAV diagnosis significantly worsens long-term survival, highlighting the need for preventive strategies.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Cardiac allograft vasculopathy (CAV) is a complex condition and a primary driver of graft loss post-heart transplantation.
- CAV's impact can differ based on diagnostic criteria and regional variations in transplant practices.
Purpose of the Study:
- To determine the prevalence, predictive factors, and prognosis of CAV in Dutch heart transplant recipients.
- To apply the 2010 International Society for Heart and Lung Transplantation (ISHLT) nomenclature for CAV diagnosis via coronary angiography.
Main Methods:
- Analysis of 495 heart transplant recipients aged 18+ who underwent transplantation at the center.
- Inclusion criteria required at least one coronary angiography during follow-up; clinical data were collected prospectively.
Main Results:
- CAV was identified in 238 (48%) recipients.
- Prevalence rates were 18% at 4 years, 47% at 12 years, and 70% at 20 years post-transplant.
- Male donor gender and increased donor age were linked to higher CAV risk; early CAV negatively impacted long-term survival (p < 0.001).
Conclusions:
- CAV prevalence shows a steady, time-dependent increase, consistent with international trends.
- Early detection of any degree of CAV is associated with reduced post-transplant survival.
- Management should prioritize donor selection and immediate post-transplant preventive measures.
Background:
Cardiac allograft vasculopathy (CAV) is a multifactorial disease and a major cause of graft failure after heart transplantation. However, the impact of CAV may vary according to the definition and the regional differences in transplantation settings.
Objectives:
We sought to assess CAV prevalence, predictors and prognosis in Dutch heart transplant recipients based on coronary angiography, following the 2010 standard nomenclature of the International Society for Heart and Lung Transplantation.
Methods:
Patients ≥18 years who underwent heart transplantation at our centre with at least one coronary angiography during follow-up were included in the analysis. Clinical variables were collected prospectively.
Results:
Among 495 analysed recipients, there were 238 (48 %) with CAV. The prevalence of CAV was 18, 47 and 70 % at 4, 12 and 20 years, respectively. In the multivariable proportional hazards regression analysis, only male donor gender and increasing donor age were significantly associated with the risk of CAV. The long-term prognosis of the patients with CAV at fourth-year angiography was significantly worse as compared with that of CAV-free patients, independently of the severity of CAV (p < 0.001).
Conclusion:
The prevalence of CAV increased gradually over time, with a similar trend as in other registries. Post-transplant survival is decreased in patients with any degree of early CAV, indicating that management strategies should start with donor selection and preventive measures immediately after transplantation.
