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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.


CAV prevalence in survivors after heart transplantation
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Fig2: CAV prevalence in survivors after heart transplantation

Mentions: A total of 238 (48.1 %) transplant recipients received the diagnosis of CAV. Mean time to CAV detection was 6.1 ± 4.2 years after transplant, with the median at the fourth year after transplantation, when CAG was routinely performed according to the follow-up protocol. The majority of the affected patients (60.1 %) had a mild CAV (grade 1), while 12.6 % of the patients had severe CAV (grade 3) at diagnosis (Table 1). The prevalence of CAV increased gradually from 17.6 % at 4 years to 47 % at 12 years and 69.7 % at 20 years, while the number of surviving transplant recipients decreased during the follow-up period (Fig. 2).Table 1


Cardiac allograft vasculopathy in Dutch heart transplant recipients
CAV prevalence in survivors after heart transplantation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: CAV prevalence in survivors after heart transplantation
Mentions: A total of 238 (48.1 %) transplant recipients received the diagnosis of CAV. Mean time to CAV detection was 6.1 ± 4.2 years after transplant, with the median at the fourth year after transplantation, when CAG was routinely performed according to the follow-up protocol. The majority of the affected patients (60.1 %) had a mild CAV (grade 1), while 12.6 % of the patients had severe CAV (grade 3) at diagnosis (Table 1). The prevalence of CAV increased gradually from 17.6 % at 4 years to 47 % at 12 years and 69.7 % at 20 years, while the number of surviving transplant recipients decreased during the follow-up period (Fig. 2).Table 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.