Related Experiment Video
Updated: Jul 18, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Prevalence, Characteristics, and Prognostic Relevance of Donor-Transmitted Coronary Artery Disease in Heart
David Couto-Mallón1, Luis Almenar-Bonet2, Eduardo Barge-Caballero3
1Cardiology Department, Hospital Universitario de A Coruña, A Coruña, Spain; Universidade de A Coruña, Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
Insights
Donor-transmitted coronary artery disease (TCAD) in heart transplantation (HT) impacts cardiovascular outcomes. Significant TCAD (s-TCAD) predicts higher cardiovascular mortality and MACE, but not overall survival in early post-transplant patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- The prevalence and prognostic significance of donor-transmitted coronary artery disease (TCAD) following heart transplantation (HT) are not well-established.
- Existing data on TCAD in HT recipients show variability, necessitating further investigation.
Purpose of the Study:
- To characterize TCAD in a contemporary, multicenter heart transplant cohort.
- To evaluate the prognostic impact of TCAD on clinical outcomes after HT.
Main Methods:
- Retrospective analysis of 1,918 adult HT patients from 11 Spanish centers (2008-2018).
- Coronary angiography within 3 months post-HT was performed on 937 patients.
- Significant TCAD (s-TCAD) defined as ≥50% stenosis; nonsignificant TCAD (ns-TCAD) as <50% stenosis.
- Clinical outcomes assessed using Cox and competing risks regression over a median 6.3-year follow-up.
Main Results:
- TCAD was identified in 18.3% of patients (6.9% s-TCAD, 11.4% ns-TCAD).
- s-TCAD was an independent predictor of cardiovascular mortality (aHR 2.25) and MACE (aHR 2.42).
- No significant association was found between s-TCAD and all-cause mortality, nor any impact of ns-TCAD on outcomes.
Conclusions:
- In early post-heart transplant patients, significant TCAD does not affect overall survival but increases the risk of cardiovascular death and major adverse cardiovascular events (MACE).
- Nonsignificant TCAD showed no discernible impact on clinical outcomes.
Background:
The reported prevalence of donor-transmitted coronary artery disease (TCAD) in heart transplantation (HT) is variable, and its prognostic impact remains unclear.
Objectives:
The goal of this study was to characterize TCAD in a contemporary multicentric cohort and to study its prognostic relevance.
Methods:
This was a retrospective study of consecutive patients >18 years old who underwent HT in 11 Spanish centers from 2008 to 2018. Only patients with a coronary angiography (c-angio) within the first 3 months after HT were studied. Significant TCAD (s-TCAD) was defined as any stenosis ≥50% in epicardial coronary arteries, and nonsignificant TCAD (ns-TCAD) as stenosis <50%. Clinical outcomes were assessed by means of Cox regression and competing risks regression. Patients were followed-up for a median period of 6.3 years after c-angio.
Results:
From a cohort of 1,918 patients, 937 underwent c-angio. TCAD was found in 172 patients (18.3%): s-TCAD in 65 (6.9%) and ns-TCAD in 107 (11.4%). Multivariable Cox regression analysis did not show a statistically significant association between s-TCAD and all-cause mortality (adjusted HR: 1.44; 95% CI: 0.89-2.35; P = 0.141); however, it was an independent predictor of cardiovascular mortality (adjusted HR: 2.25; 95% CI: 1.20-4.19; P = 0.011) and the combined event cardiovascular death or nonfatal MACE (adjusted HR: 2.42; 95% CI: 1.52-3.85; P < 0.001). No statistically significant impact of ns-TCAD on clinical outcomes was detected. The results were similar when reassessed by means of competing risks regression.
Conclusions:
TCAD was not associated with reduced survival in patients alive and well enough to undergo post-HT angiography within the first 3 months; however, s-TCAD patients showed increased risk of cardiovascular death and MACE.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:26Coronary Artery Disease II: Pathophysiology
01:30Coronary Artery Disease III: Clinical Manifestations
01:30Coronary Artery Disease I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies