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Coronary artery disease in patients with hearts from older donors: morphologic features and therapeutic implications
S Schüler1, K Matschke, M Loebe
1German Heart Institute Berlin.
Insights
Hearts from older donors show normal function in recipients. While diffuse coronary artery disease risk is similar, focal disease is higher but treatable, indicating older donor hearts are viable options.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Coronary artery disease (CAD) is a significant concern in heart transplant recipients.
- The impact of donor age on long-term graft function and CAD development requires further investigation.
Purpose of the Study:
- To evaluate the risk of postoperative coronary artery disease in heart transplant recipients receiving grafts from older donors.
- To compare graft function and CAD patterns between hearts from younger and older donors.
Main Methods:
- A retrospective study of 234 long-term heart transplant survivors (follow-up > 12 months).
- Annual cardiac catheterization was performed to assess graft function and identify CAD.
- Patients were divided into two groups based on donor age: younger (Group I) and older (Group II).
Main Results:
- No significant difference in graft function (ejection fraction, pressures) was observed between hearts from younger and older donors.
- Two CAD patterns were identified: diffuse (Type 1) and focal (Type 2).
- Type 1 CAD occurred with similar incidence in both groups (5%), but Type 2 CAD was significantly higher in the older donor group (18% vs. 4%, p < 0.001).
- Type 1 CAD led to graft failure in some patients, while Type 2 CAD was successfully treated with percutaneous transluminal coronary angioplasty or bypass grafting.
Conclusions:
- Hearts from older donors exhibit normal graft function post-transplantation.
- The risk of diffuse coronary artery disease is not increased with older donor hearts.
- A higher incidence of focal coronary artery disease in older donor hearts suggests donor-transmitted disease, which is amenable to conventional therapies.
Abstract:
Of 558 heart transplant recipients, 234 long-term survivors (more than 12 months) were studied by annual catheterization to evaluate the risk of postoperative coronary artery disease in hearts from older donors. No significant difference was found in graft function between hearts from younger and older donors (group I: n = 157, mean donor age 23 +/- 5 years, mean follow-up 45 +/- 22 months; group II: n = 77, mean donor age 43 +/- 5 years, mean follow-up 42 +/- 22 months) as indicated by left and right ventricular ejection fraction, pulmonary artery pressure, and pulmonary capillary wedge pressure. Two morphologic patterns of coronary artery disease were observed: a diffuse type of concentric narrowing of the arteries (type 1) and a focal type with proximal single-vessel stenosis (type 2). Type 1 occurred in eight patients (5%) in group I and in four patients in group II (5%) (p = not significant). Type 1 coronary artery disease led to graft failure in seven patients in group I and two patients in group II. Type 2 coronary artery disease occurred in seven patients (4%) in group I and in 14 (18%) in group II (p < 0.001). No death was related to graft failure in patients with type 2 coronary artery disease. Eight patients with type 2 coronary artery disease were successfully treated by percutaneous transluminal coronary angioplasty; one patient underwent coronary artery bypass grafting. Hearts from older donors provide normal graft function. The risk of diffuse coronary artery disease is not elevated in comparison to hearts from younger donors. The higher incidence of focal coronary artery disease suggests donor-transmitted disease that can successfully be treated by conventional therapy.