17 November 2017 : Original article
Heart Transplantation and Risk of Cardiac Vasculopathy Development: What Factors Are Important?Małgorzata Sobieszczańska-Małek1ABCDEF*, Jerzy Korewicki1ADF, Krzysztof Komuda1BDF, Małgorzata Karczmarz1BDF, Sylwia Szymańska2BDE, Alicja Cicha-Mikołajczyk3CD, Paweł Bekta4BD, Adam Parulski5BD, Maciej Pronicki2BD, Wiesława Grajkowska6BD, Grzegorz Małek7BCE, Przemysław Leszek8CE, Maria Kaczorowska9BF, Mariusz Kuśmierczyk5AD, Tomasz Zieliński8ACDEG
Ann Transplant 2017; 22:682-688
BACKGROUND: The aim of this study was to find the main risk factors for development of cardiac allograft vasculopathy (CAV), especially factors identified before the surgical procedure and factors related to the recipient profile and the medical history of the donor.
MATERIAL AND METHODS: There were 147 patients who had heart transplantation (HT) included in this study: mean age was 45.8±15.3 years. All study patients had coronary angiography after HT. Analyzed risk factors were: non-immunologic recipient risk factors (age of transplantation, smoking, hypertension, lipids, diabetes, obesity and weight gain after HT), immunologic recipient risk factors (acute cellular rejection (ACR), acute humoral rejection (AMR), cytomegalovirus (CMV) episodes), and donor-related risk factors (age, sex, catecholamine usage, ischemic time, compatibility of sex and blood groups, cause of death, cardiac arrest).
RESULTS: CAV was recognized in 48 patients (CAV group); mean age 53.6±13.6 years. There were 99 patients without CAV (nonCAV group); mean age 48.3±15.5 years. A univariate Cox analysis of the development of coronary disease showed statistical significance (p<0.05) for baseline high-density lipid (HDL), ACR, AMR, CMV, and donor age. Multivariate Cox regression model confirmed that only baseline HDL, episodes of ACR, donor age, and CMV infection are significant for the frequency of CAV after HT.
CONCLUSIONS: Older donor age is highly associated with CAV development. Older donor age and low level of HDL in heart recipients with the strongest influence of immunologic risk factors (ACR, CMV infection) were linked with development of CAV.
Keywords: Coronary Artery Disease, Heart Transplantation, Risk Factors
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