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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.


Forest plot of risk factors included in the multivariate Cox proportional hazard modelling
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Fig3: Forest plot of risk factors included in the multivariate Cox proportional hazard modelling

Mentions: In the multivariable proportional hazard regression analysis only male donor gender and donor age were significantly associated with CAV, with a gradual increased hazard risk of 1.5, 2.2 and 2.8 in the three consecutive groups of donor age, while post-transplantation clinical factors were not significant (Fig. 3). The treatment with mycophenolate mofetil was associated with a significantly increased risk (HR 1.4, p = 0.008) only in the univariate analysis, while cytomegalovirus disease was associated with an increased hazard risk for CAV (HR 1.3, p = 0.059), although not significant, in the univariate analysis (Table 3).Fig. 3


Cardiac allograft vasculopathy in Dutch heart transplant recipients
Forest plot of risk factors included in the multivariate Cox proportional hazard modelling
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Forest plot of risk factors included in the multivariate Cox proportional hazard modelling
Mentions: In the multivariable proportional hazard regression analysis only male donor gender and donor age were significantly associated with CAV, with a gradual increased hazard risk of 1.5, 2.2 and 2.8 in the three consecutive groups of donor age, while post-transplantation clinical factors were not significant (Fig. 3). The treatment with mycophenolate mofetil was associated with a significantly increased risk (HR 1.4, p = 0.008) only in the univariate analysis, while cytomegalovirus disease was associated with an increased hazard risk for CAV (HR 1.3, p = 0.059), although not significant, in the univariate analysis (Table 3).Fig. 3

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.