Factors influencing early onset of coronary allograft vasculopathy after orthotopic heart transplantation

Introduction: Heart transplantation is a common surgical procedure for treatment of end stage heart failure. Almost 85.000 operations have been performed worldwide over the past 40 years. However, coronary allograft vasculopathy, which is a phenomenon of chronic rejection, is still a serious problem. The aim of this retrospective study was to identify factors influencing the time point of onset of coronary allograft vasculopathy.

Methods: Medical records of heart transplant recipients transplanted between 1998 and 2008 surviving transplantation for at least one year were screened for 25 factors possibly influencing onset of coronary allograft vasculopathy retrospectively. Annual coronary angiograms were analysed for signs of coronary allograft vasculopathy.

Results: Overall 244 patients were included into the study and 1112 coronary angiograms were screened. Median survival in all patients was 185±10 months. Patients with onset of coronary allograft vasculopathy within the first 48 months after transplantation had a significantly shorter long-term-survival than those were coronary allograft vasculopathy occurred later (149±11 vs. 190±7 months; p=0.02). Factors significantly associated with early onset of coronary allograft vasculopathy were age over 45 years at transplantation, donor age over 40 years, creatinine clearance under 45ml/min, gender mismatch between donor and recipient, prolonged ischemia-time and cholesterol levels over 200mg/dl.

Conclusion: Onset of coronary allograft vasculopathy within the first 48 months after transplantation is associated with impaired long-term-survival. Short ischemia-time and strict control of cholesterol levels are factors which might help to delay onset of coronary allograft vasculopathy and thereby improve long-term-survival.