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Cardiac allograft vasculopathy: Incidence and predictors in a single-center cohort
Sofia Picão1, Manuel Oliveira-Santos1, Manuel Batista1
1Centro Hospitalar da Universidade de Coimbra, Coimbra, Portugal.
Insights
Cardiac allograft vasculopathy (CAV) is a major complication after heart transplants. Previous ischemic heart disease, carotid artery disease, and donor age predict CAV development in transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Cardiac allograft vasculopathy (CAV) is a leading cause of graft loss after heart transplantation.
- Identifying CAV predictors is crucial for improving long-term outcomes in transplant recipients.
Purpose of the Study:
- To determine the incidence of CAV in a large cohort of orthotopic heart transplantation (OHT) patients.
- To identify clinical and demographic predictors associated with CAV development.
Main Methods:
- Retrospective analysis of a prospective cohort of 233 OHT patients transplanted between 2003 and 2014.
- Analysis of 712 invasive coronary angiograms and baseline clinical data by two independent investigators.
Main Results:
- The study included 202 patients (157 male, 45 female) with a median age of 66 years.
- CAV was diagnosed in 18% of patients over a median follow-up of 2920 days (incidence: 2.91 cases/100 person-years).
- Predictors of CAV included prior ischemic heart disease (HR 2.32), carotid artery disease (HR 2.44), and donor age (HR 1.04).
Conclusions:
- Previous ischemic heart disease, carotid artery disease, and donor age are significant predictors of CAV in OHT patients.
- These findings can aid in risk stratification and personalized management strategies for heart transplant recipients.
Introduction And Aims:
Cardiac allograft vasculopathy (CAV) is one of the most significant complications after orthotopic heart transplantation. We aimed to investigate the incidence and predictors of CAV in a large cohort of orthotopic heart transplantation patients.
Methods:
We conducted a retrospective analysis on a prospective cohort of 233 patients who underwent transplantation between November 2003 and May 2014. Baseline clinical data and invasive coronary angiograms (n=712) performed as part of the follow-up program were analyzed by two independent investigators.
Results:
We included 157 male and 45 female patients with a median age of 66 years. A third of patients had previous ischemic heart disease, 30% peripheral arterial disease, 37% hypertension and 47% dyslipidemia, and 17% were smokers. Acute moderate or severe rejection occurred in 42 patients during the first year. Over a median follow-up of 2920 days, 18% were diagnosed with CAV, with an incidence of 2.91 cases per 100 person-years. Predictors of CAV were previous ischemic heart disease (HR 2.32, 95% CI 1.21-4.45, p=0.01), carotid artery disease (HR 2.44, 95% CI 1.27-4.71, p<0.01), and donor age (HR 1.04, 95% CI 1.00-1.07, p=0.01).
Conclusion:
In a single-center cohort of orthotopic heart transplantation patients, predictors of CAV were previous ischemic heart disease, carotid artery disease and donor age.
