進行したCAVを有する小児心移植レシピエントにおける経皮的冠動脈インターベンション：避けられないものの遅延

Coronary allograft vasculopathy (CAV) is a leading cause of allograft failure in pediatric heart transplant recipients. Percutaneous coronary intervention (PCI) is performed to manage atherosclerotic coronary artery disease. However, there is currently limited data regarding use and long-term benefit of PCI due to the diffuse nature of coronary disease in CAV. We sought to evaluate our experience utilizing PCI for CAV. Patients followed at our center who were transplanted as pediatric patients who developed CAV and subsequently underwent PCI were included. Demographic variables were collected, including pre- and post-transplant, pre- and post-PCI, and follow-up data. Categorical variables are presented as N (%) and continuous variables as median (IQR). Kaplan-Meier survival estimates approximated freedom from retransplantation or death. Our cohort had 17 patients who underwent 21 PCI procedures. Of these, 9 (52.9%) were males, 10 (58.8%) were white, and the median age at transplant was 13.6 years [10.4,16.4]. The median age at CAV detection was 16.2 [13.8,19.1] years, and the median time from transplant to first PCI was 7.7 years [5.5,9.2]. Five patients had congenital heart disease, 12 had cardiomyopathy as indication for transplantation. At last follow-up, 4 patients required a repeat PCI, 3 patients underwent retransplant, and 5 patients died. Kaplan-Meier estimates show freedom from death or retransplantation of 88% at 1 years, 64% at 3 years, and 57% at 5 years after initial PCI. In our cohort with advanced CAV, PCI showed favorable immediate outcomes with freedom from death or retransplant in 57% patients at 5 years.