Higher Donor Body Mass Index Is Associated with Higher Risk of Cardiac Allograft Vasculopathy

Abstract

Purpose Donor and recipient characteristics that are associated with high risk of cardiac allograft vasculopathy (CAV) have not been fully elucidated. We sought to examine risk factor associations with CAV among cardiac transplant patients in our center. Methods and Materials The cardiac transplant database of a single academic center from 2003-11 was retrospectively reviewed. The outcome of CAV was defined as ≥60% stenosis in ≥1 major coronary vessel or >30% in >1 vessel. The following variables were analyzed for their association with the outcome: donor and recipient age, gender, body mass index (kg/m2), smoking, diabetes, hypertension, dyslipidemia, chronic kidney disease, cytomegalovirus/ ebstein barr virus serology and frequency of acute cellular rejection episodes within 12 months from transplantation. Cox proportional hazards regression was used to determine the association between variables and outcome. Results Of 85 transplant recipients analyzed, mean age 47; male 75%. CAV was diagnosed in 23 (27%) patients over a mean follow-up of 3.5 years. After multivariate analysis adjusting for mentioned parameters, only donor BMI was significantly associated with a higher risk of CAV (OR 1.1, 95%CI 1.0-1.2, P=0.03). For every 1 point increase in BMI, there was a 11% increase in CAV risk. The optimal cut-off for BMI to predict CAV was determined as 24. Figure 1 displays the Kaplan-Meier curves for time to CAV stratified based on BMI ≥24 (solid line) and Conclusions Higher donor BMI was independently associated with an increased risk of CAV after cardiac transplantation. Careful screening of this donor characteristic may be necessary for favorable recipient outcomes.