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Cardiac allograft vasculopathy in Dutch heart transplant recipients

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ABSTRACT

Background: Cardiac allograft vasculopathy (CAV) is a multifactorial disease and a major cause of graft failure after heart transplantation. However, the impact of CAV may vary according to the definition and the regional differences in transplantation settings.

Objectives: We sought to assess CAV prevalence, predictors and prognosis in Dutch heart transplant recipients based on coronary angiography, following the 2010 standard nomenclature of the International Society for Heart and Lung Transplantation.

Methods: Patients ≥18 years who underwent heart transplantation at our centre with at least one coronary angiography during follow-up were included in the analysis. Clinical variables were collected prospectively.

Results: Among 495 analysed recipients, there were 238 (48 %) with CAV. The prevalence of CAV was 18, 47 and 70 % at 4, 12 and 20 years, respectively. In the multivariable proportional hazards regression analysis, only male donor gender and increasing donor age were significantly associated with the risk of CAV. The long-term prognosis of the patients with CAV at fourth-year angiography was significantly worse as compared with that of CAV-free patients, independently of the severity of CAV (p < 0.001).

Conclusion: The prevalence of CAV increased gradually over time, with a similar trend as in other registries. Post-transplant survival is decreased in patients with any degree of early CAV, indicating that management strategies should start with donor selection and preventive measures immediately after transplantation.

No MeSH data available.


Flowchart study population
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Fig1: Flowchart study population

Mentions: From the cohort of 612 heart transplant recipients, 495 were included in the analysis (Fig. 1). The mean age at transplantation was 48.6 ± 10.3 years, and 77.4 % of recipients were males. Ischaemic heart disease was the cause of heart failure before transplantation in 49.9 % of the patients. Diabetes was present in 6.1 % of the patients before transplantation. Mean donor age was 33.3 ± 12.9 years and 52.7 % of the donors were males. The cause of death was trauma in 48.8 % of the donors. During the first year post-transplantation, hypertension, diabetes and cytomegalovirus disease were present in 75, 32 and 20 % of the patients, respectively. At one year after transplantation only a minority of the recipients (22.6 %) were free of any rejection episodes, while 21.6 % had more than two rejection episodes.Fig. 1


Cardiac allograft vasculopathy in Dutch heart transplant recipients
Flowchart study population
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120004&req=5

Fig1: Flowchart study population
Mentions: From the cohort of 612 heart transplant recipients, 495 were included in the analysis (Fig. 1). The mean age at transplantation was 48.6 ± 10.3 years, and 77.4 % of recipients were males. Ischaemic heart disease was the cause of heart failure before transplantation in 49.9 % of the patients. Diabetes was present in 6.1 % of the patients before transplantation. Mean donor age was 33.3 ± 12.9 years and 52.7 % of the donors were males. The cause of death was trauma in 48.8 % of the donors. During the first year post-transplantation, hypertension, diabetes and cytomegalovirus disease were present in 75, 32 and 20 % of the patients, respectively. At one year after transplantation only a minority of the recipients (22.6 %) were free of any rejection episodes, while 21.6 % had more than two rejection episodes.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Cardiac allograft vasculopathy (CAV) is a multifactorial disease and a major cause of graft failure after heart transplantation. However, the impact of CAV may vary according to the definition and the regional differences in transplantation settings.

Objectives: We sought to assess CAV prevalence, predictors and prognosis in Dutch heart transplant recipients based on coronary angiography, following the 2010 standard nomenclature of the International Society for Heart and Lung Transplantation.

Methods: Patients ≥18 years who underwent heart transplantation at our centre with at least one coronary angiography during follow-up were included in the analysis. Clinical variables were collected prospectively.

Results: Among 495 analysed recipients, there were 238 (48 %) with CAV. The prevalence of CAV was 18, 47 and 70 % at 4, 12 and 20 years, respectively. In the multivariable proportional hazards regression analysis, only male donor gender and increasing donor age were significantly associated with the risk of CAV. The long-term prognosis of the patients with CAV at fourth-year angiography was significantly worse as compared with that of CAV-free patients, independently of the severity of CAV (p < 0.001).

Conclusion: The prevalence of CAV increased gradually over time, with a similar trend as in other registries. Post-transplant survival is decreased in patients with any degree of early CAV, indicating that management strategies should start with donor selection and preventive measures immediately after transplantation.

No MeSH data available.