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Retransplantation for severe accelerated coronary artery disease in heart transplant recipients
S Z Gao1, J S Schroeder, S Hunt
1Division of Cardiology, Stanford University School of Medicine, California 94305.
Insights
Accelerated coronary artery disease (CAD) in heart transplants leads to graft failure. Risk factors include more rejection episodes and higher cholesterol, impacting survival after retransplantation.
Area of Science:
- Cardiology
- Transplantation Immunology
- Graft Failure Research
Background:
- Accelerated coronary artery disease (CAD) is a primary cause of late graft failure in heart transplant recipients.
- Stanford University Medical Center performed 356 heart transplants by January 1985, with 89 patients developing transplant CAD.
Purpose of the Study:
- To identify risk factors associated with the development of severe transplant CAD.
- To compare patients who underwent retransplantation due to CAD with those who did not develop CAD.
Main Methods:
- Retrospective analysis of 20 retransplant procedures for CAD against 113 control recipients without CAD.
- Comparison of rejection episodes, total cholesterol, and low-density lipoprotein (LDL) levels.
Main Results:
- The retransplant group showed significantly more rejection episodes (3 +/- 2 vs. 2 +/- 1, p=0.02).
- Elevated total cholesterol (266 +/- 78 vs. 225 +/- 47 mg/dl, p=0.002) and LDL levels (176 +/- 88 vs. 137 +/- 46 mg/dl, p=0.009) were observed in the CAD group.
- Five of 11 long-term survivors ( > 1 year) in the retransplant group developed recurrent transplant CAD.
Conclusions:
- Rejection episodes, high cholesterol, and LDL levels are significant risk factors for developing severe transplant CAD.
- Transplant CAD in the second graft exhibits similar characteristics and rapid progression as in the primary graft.
- Graft survival after a second transplant for CAD is limited, with substantial rates of re-development of the disease.
Abstract:
Development of accelerated coronary artery disease (CAD) in the cardiac allograft is one of the major causes of late graft failure in heart transplant recipients. At the Stanford University Medical Center 356 heart transplant procedures were performed in 329 patients by the end of January 1985. Eighty-nine of these patients developed evidence of transplant CAD. Twenty retransplant procedures, including 2 third transplants, were performed in 19 of the 89 patients because of transplant CAD. The graft survival rates after the second transplant were 55%, 25% and 10% after 1, 2 and 5 years, respectively. Nine of these retransplant patients currently survive, the longest for 5.5 years. To examine potential risk factors for development of severe transplant CAD, these 20 retransplant procedures were compared with 113 transplant recipients who had no evidence of transplant CAD on annual coronary arteriograms. An excess of rejection episodes (3 +/- 2 vs 2 +/- 1 episodes/patient, p = 0.02), elevated total cholesterol (266 +/- 78 vs 225 +/- 47 mg/dl, p = 0.002) and higher low-density lipoprotein levels (176 +/- 88 vs 137 +/- 46 mg/dl, p = 0.009) were noted in the transplant CAD retransplant group. Five of 11 retransplant recipients who survived greater than 1 year again developed transplant CAD. Characteristic morphologic features and rapid progression of CAD in the second graft were similar to those in the primary graft.(ABSTRACT TRUNCATED AT 250 WORDS)