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Cardiac allograft vasculopathy after heart transplantation: Is it really ominous?
Ju Yong Lim1, Sung Ho Jung1, Min Seok Kim2
1Departments of Thoracic and cardiovascular surgery, Asan medical center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Cardiac allograft vasculopathy (CAV) after heart transplantation (HT) is often stationary and does not impact survival. Key risk factors for CAV include donor/recipient age, prolonged ischemic time, and postoperative renal replacement therapy.
Area of Science:
- Cardiology
- Transplantation Immunology
- Clinical Research
Background:
- Cardiac allograft vasculopathy (CAV) is a significant barrier to long-term success in heart transplantation (HT).
- Understanding the incidence, progression, and risk factors of CAV is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and disease course of CAV in heart transplant recipients.
- To identify predictors associated with the development of CAV.
Main Methods:
- A retrospective review of 399 heart transplant recipients between November 1992 and July 2014.
- Analysis of CAV development and composite outcomes (death or re-HT) in 297 survivors.
Main Results:
- CAV was detected in 54 patients (18.2%) over a mean follow-up of 5.6 years.
- Most CAV cases were mild (CAV 1: 83.3%) and did not progress significantly.
- Predictors of CAV included older donor age, older recipient age, prolonged ischemic time (>240 min), postoperative renal replacement therapy, and elevated triglyceride levels at 1 year post-HT.
Conclusions:
- The incidence of CAV post-heart transplantation is acceptable, with a low rate of progression and minimal impact on survival.
- Donor and recipient age, ischemic time, postoperative renal replacement therapy, and triglyceride levels are significant factors influencing CAV development.
Objectives:
Cardiac allograft vasculopathy (CAV) remains a major impediment to long-term survival after heart transplantation (HT). We investigated the incidence, disease course, and risk factors for CAV.
Methods:
Among 399 patients who underwent HT between November 1992 and July 2014, 297 survivors were reviewed. Endpoints were CAV development and the composite outcome of death or re-HT.
Results:
During 5.6±5.2 years, CAV was detected in 54 patients: 45 (83.3%), 8 (14.8%), and 1 (1.8%) patients for CAV 1, 2, and 3, respectively. At 1, 5, and 10 years, 99.0%, 82.4%, and 60.3% of patients were free of CAV, respectively. Only four patients (7.4%) showed progression over 4.8±2.1 years' follow-up. The presence of CAV did not affect the composite outcome (P=.89). Predictors of CAV included donor age (HR1.06, 95% CI: 1.03-1.10: P<.001), recipient age (1.03 [1.003-1.06]; P=.03), ischemic time >240 minutes (3.15 [1.36-7.28], P=.007), postoperative renal replacement therapy (RRT) (7.1 [2.3-21.8]; P=.001), and triglyceride level at 1 year post-HT (1.005 [1.002-1.008], P=.003).
Conclusions:
CAV incidence after HT appears acceptable, with most cases being stationary and inconsequential for survival. Development of CAV seems to be influenced by donor and recipient age, ischemic time, postoperative RRT, and high triglyceride level.
