Cardiac allograft vasculopathy outcomes among donation after circulatory death heart transplant recipients

Abstract

Cardiac allograft vasculopathy accounts for significant long-term morbidity and mortality in heart transplant recipients; limited data exists for donation after circulatory death. Intravascular ultrasound assessment is a gold standard for early diagnosis of CAV and has strong prognostic power. We evaluated all consecutive circulatory and brain death heart transplant recipients from January 2020 to March 2022. Patients were followed for need for percutaneous coronary intervention, development of severe allograft vasculopathy or death. Among 143 heart transplant recipients, 39 received circulatory death and 104 received brain death hearts. Baseline characteristics were similar between groups: median age (56.3 vs 53.7 years, p = 0.290), female sex (15% vs 26%, p = 0.265) and sirolimus use (69% vs 53%, p = 0.116). At 1 year, there were no significant differences in maximal intimal thickness (0.49 vs. 0.46 mm, p = 0.861) or Stanford classification. During a median follow-up of 793 days [IQR 618, 1003], there was no difference in the unadjusted or adjusted primary composite outcome of death, PCI, or ISHLT cardiac allograft vasculopathy MIT > 0.6mm (unadjusted HR 0.42, 95% CI: 0.05, 3.48, p = 0.42), event rate 9.6% vs 2.6%, p= 0.29, nor was there a difference in death, PCI or severe IVUS disease (HR 1.44, 95% CI 0.81, 2.56, p = 0.21). In DCD heart transplant recipients, circulatory death donors did not have a significantly higher risk for coronary allograft vasculopathy by IVUS or related complications at one year following transplantation.