Abstract
BackgroundCardiac 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.ObjectivesWe 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.MethodsPatients ≥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.ResultsAmong 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).ConclusionThe 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.
Highlights
Cardiac allograft vasculopathy (CAV) is one of the major causes of late graft failure and death in heart transplant patients [1]
Posttransplant 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
The reported CAV prevalence varies according to the definition, population, transplantation period and follow-up protocol and ranges from 39 to 65 % at 10 years in single-centre studies, while in the large register of the International Society for Heart and Lung Transplantation (ISHLT) it is 50 % at 10 years [1,2,3]
Summary
Cardiac allograft vasculopathy (CAV) is one of the major causes of late graft failure and death in heart transplant patients [1]. The reported CAV prevalence varies according to the definition, population, transplantation period and follow-up protocol and ranges from 39 to 65 % at 10 years in single-centre studies, while in the large register of the International Society for Heart and Lung Transplantation (ISHLT) it is 50 % at 10 years [1,2,3]. Cardiac allograft vasculopathy (CAV) is a multifactorial disease and a major cause of graft failure after heart transplantation. The impact of CAV may vary according to the definition and the regional differences in transplantation settings
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