Coronary Artery Disease of the Donor Graft: Any Impact on Survival and Cardiac Allograft Vasculopathy after Heart Transplantation?

Abstract

Cardiac allograft vasculopathy (CAV) represents a relevant issue after Heart Transplantation (HTx), affecting mid and long-term outcomes. Coronary artery disease (CAD) of the donor graft has been implicated in the pathogenesis and progression of CAV. Although definitive data are still lacking, CAD of the donor graft represents an exclusion criteria in many transplant Units. We analyzed the outcomes of patients who underwent HTx from donor hearts affected by no-severe CAD. Patients who received a graft, evaluated with coronary angiogram before the retrieval, were divided into two groups according to the presence or not of no-severe CAD (with lesions ≤50%) of the donor graft (groups CAD and NCAD, respectively). The outcomes analyzed were survival and freedom from grade ≥2 CAV. The study period was between 1990 and 2018. Median follow up was 86 months (range 0.3-317). There were differences between CAD and NCAD groups according to the baseline characteristics, as reported in Table 1. Survival and Freedom from grade ≥2 CAV were similar between the two groups at mid term (p=0.47 and p=0.66, Figure 1). At adjusted multivariate analysis for both survival and freedom from grade ≥2 CAV, donor CAD was not considered a significant risk factor. Coronary angiogram plays a reliable role in identifying suitable organs, even those affected by CAD. In fact, no-severe donor CAD does not seem to affect survival and development of high grade CAV, more likely due to immunological factors. If confirmed by larger studies, these finding could encourage the employment of donor hearts affected by CAD.