Impact of donor-transmitted coronary atherosclerosis on outcome after heart transplantation

Background: Due to the shortage of donor hearts the criteria for organ acceptability have been considerably extended. Therefore, the probability of transmission of atherosclerotic lesions by means of transplantation has increased. The purpose of this study was to evaluate the impact of preexisting coronary atherosclerosis (CAS) on the outcome of transplantation.

Material and Methods: Between 4/1986 and 12/2000 1253 patients underwent heart transplantation at our institution. In 1168 of these patients the coronary arteries were investigated by angiography (n=950) or autopsy (n=218) within 6 months after transplantation. Focal and noncircumferential atherosclerosis with 50% stenosis in proximal segments was regarded as native and transmitted CAS rather than transplant vasculopathy. Hazard function and Kaplan-Meier analysis were used.

Results: In 82 patients CAS was diagnosed by angiography (n=49) or autopsy (n=33) (CAS group) and in 1086 patients no CAS was found (NCAS group). Early after HTX the instantaneous risk to die was threefold higher in the CAS group (0.17 vs. 0.05); however, beyond the first year the annual decrease in the CAS and NCAS groups was comparable (4.2%/year vs. 5.4%/year, p>0.05). Furthermore, incidence of graft vessel disease (GVD) and health-related quality of life (SF-36 questionnaire) were comparable (p>0.05). Only biopsy-proven micro-GVD, i.e. severe proliferative vascular wall thickening, was found more often in the CAS group after 5 years (83.8% vs. 74.9%, p=0.005) but this was without further clinical implications.

Conclusions: Transmitted CAS impairs the short-term but not the long-term outcome after HTX. Nevertheless, coronary angiography of donor hearts should be performed liberally, i.e. in donors 40 years old.