369: Prophylaxis vs. Pre-Emptive Strategies in Preventing Cytomegalovirus-Dependent Cardiac Allograft Vasculopathy

Abstract

formed at 1 week, 1 and 5 years after HTx were analyzed in 104 heart recipients. The mean age of the cohort was 47 16 years and the period of follow up was 4.96 2.45 years. The total cohort was divided into three sub-groups based on determination of LV geometry at 1-week after transplantation: (1) NG normal left ventricle geometry (relative wall thickness (RWT) 0.42 and LVM 225 for males and 163 for females); (2) CR concentric remodeling (RWT 0.42, LVM 225 for males and 163 for females); and (3) CH concentric hypertrophy (RWT 0.42, LVM 225 for males and 163 for females). Results: Abnormal LV geometry was found as early as 1 week after HTx in 85% of patients (59% CR, 26% CH) with explosive mode of donor brain death being the most significant determinant for CH (OR 2.9, CI 0.4-3.18, p 0.01) by multivariable logistic regression. There was no significant difference in blood pressure control or cellular rejection score between the 3 groups. Patients with abnormal LV geometry at 1 week had significantly higher prevalence of graft vasculopathy by angiography at 5 years (0% in NG, 9% in CR and 30% in CH, p 0.0015). The prevalence of CH continued to increase to 30% at 1 year and 41% at 5 years after HTx primarily due to a progressive increase in RWT and LV mass in the NG group and increase in LV mass in the CR group. Patients with CH at 1 year had significantly higher mortality as compared to patients with normal LV geometry (RR-1.87, p 0.03). Conclusions: Cardiac allograft remodeling occurs early and frequently after HTX, with explosive mode of donor brain death a significant factor. Subsequently, the presence of CH is associated with increased graft arteriosclerosis and mortality.