936-88 Relationship of Donor Age and Pre-existing Coronary Disease by Angiography and Intracoronary Ultrasound to Later Development of Cardiac Allograft Coronary Artery Disease

Abstract

The increasing demand for cardiac donors has led to a tendency to liberalize age and other criteria for donor acceptability. Since cardiac allograft coronary artery disease (TxCAD) is the major complication limiting longterm post-transplant survival, we analyzed a series of 242 consecutive cardiac transplant patients (Tx pts) who had baseline early post-op coronary angios and a subset of 41 pts with baseline intracoronary ultrasound (ICUS) to determine whether either older donor age or pre-existing CAD at the time of transplant influenced the later occurrence of TxCAD. Fourteen pts had angiographic evidence of some pre-existing CAD (donor CAD group); the other 228 did not (no donor CAD group). New disease was defined as either development of new obstructive lesions or progression of old lesions on serial annual angios. Freedom from new disease was 86%, 71%, and 30% at 1, 2, and 3 years post-op in the donor CAD group and 97%, 89%, and 77% in the no donor CAD group (p = 0.003). No donor CAD pts were subdivided into older (≥40) and younger (<40) groups. Freedom from TxCAD was 92%, 52%, and 43% at 1, 3, and 5 years post-op in the older group (n = 31, mean age 49) vs. 97%, 82%, and 53% in the younger group (n = 184, mean age 24) p = 0.03 (Mantel-Haenszel). Baseline ICUS imaging revealed baseline class 3 or 4 lesions in 7 of 9 older donor hearts, and in only 7 of 32 younger hearts (p = 0.006). Three of these 14 ICUS class 3/4 pts later developed TxCAD vs. only 3 of 27 class 1/2 pts at baseline (p = NS). Older donor age, no calcium blocker use and pre-existing CAD were significant predictors for development of TxCAD (p = 0.0006, 0.0003, and 0.003 respectively, Cox regression analysis). (1) Older donors or pre-existing CAD have a greater tendency to develop TxCAD, (2) ICUS reveals moderate to severe intimal thickening not angiographically detectable and there is a trend toward such disease leading to later TxCAD.