Background

Cardiac allograft vasculopathy (CAV) is a major complication limiting long-term survival after heart transplantation (HTx). However, long-term outcome data of HTx recipients with detailed information on angiographic severity are scarce.

Methods

The study included 501 HTx recipients with angiographic follow-up up to 20 years post-transplant. All coronary angiograms were classified according to the International Society for Heart and Lung Transplantation (ISHLT) grading scale.

Results

CAV prevalence increased over time after transplantation, reaching 10% at 1 year, 44% at 10 years, and 59% at 20 years. Older donor age (hazard ratio [HR] 1.38 per 10 years, 1.20–1.59, p < 0.001), male donor sex (HR 1.86, 1.31–2.64, p < 0.001), stroke as donor cause of death (HR 1.47, 1.04–2.09, p = 0.03), recipient pre-transplant hemodynamic instability (HR 1.79, 1.15–2.77, p = 0.01), post-transplant smoking (HR 1.59, 1.06–2.39, p = 0.03), and first-year treated rejection episodes (HR 1.49, 1.01–2.20, p = 0.046) were independent risk factors for CAV. Baseline anti-metabolite drug use (HR 0.57, 0.34–0.95, p = 0.03) and more recent transplant date (HR 0.78 per 10 years, 0.62–0.99, p = 0.04) were protective factors. Compared with patients without CAV, the HR for death or retransplantation was 1.22 (0.85–1.76, p = 0.28) for CAV 1, 1.86 (1.08–3.22, p = 0.03) for CAV 2, and 5.71 (3.64–8.94, p < 0.001) for CAV 3.

Conclusions

CAV is highly prevalent in HTx recipients and is explained by immunologic and non-immunologic factors. Higher ISHLT CAV grades are independently associated with worse graft survival.

中文翻译：

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心脏同种异体血管病变的长期结果：国际心肺移植学会血管造影分级表的重要性。

背景

心脏同种异体血管病变（CAV）是限制心脏移植（HTx）后长期生存的主要并发症。但是，缺乏有关血管造影严重性的详细信息的HTx接受者的长期结局数据。

方法

该研究纳入了501位HTx接受者，并在移植后20年内进行了血管造影随访。根据国际心肺移植学会（ISHLT）分级量表对所有冠状动脉血管造影照片进行分类。

结果

移植后，CAV患病率随时间增加，在1年时达到10％，在10年时达到44％，在20年时达到59％。供体年龄较大（风险比[HR]每10年1.38，1.20-1.59，p <0.001），男性供体性别（HR 1.86，1.31-2.64，p <0.001），中风是供体死亡的原因（HR 1.47，1.04 ） –2.09，p  = 0.03），接受移植前的血流动力学不稳定（HR 1.79、1.15-2.77，p  = 0.01），移植后吸烟（HR 1.59、1.06-2.39，p  = 0.03）和治疗第一年的排斥反应发作（HR 1.49，1.01-2.20，p  = 0.046）是CAV的独立危险因素。基线抗代谢药物的使用（HR 0.57，0.34–0.95，p = 0.03）和更近期的移植日期（每10年HR 0.78，0.62-0.99，p  = 0.04）是保护性因素。与没有CAV的患者相比，CAV 1死亡或移植的HR为1.22（0.85–1.76，p  = 0.28），CAV 2为1.86（1.08–3.22，p  = 0.03），5.71（3.64–8.94，p < 0.001），适用于CAV 3。

结论

CAV在HTx受体中高度流行，并通过免疫和非免疫因素进行解释。较高的ISHLT CAV等级与较差的移植物存活率独立相关。