Donor-Transmitted Atherosclerosis Associated With Worsening Cardiac Allograft Vasculopathy After Heart Transplantation

Abstract

BackgroundThe influence of preexisting donor-transmitted atherosclerosis (DA) on cardiac allograft vasculopathy (CAV) development remains unclear.MethodsWe performed 3-dimensional intravascular ultrasound (3D-IVUS) analysis in 42 heart transplantation (HTx) recipients at 2.1 ± 0.9 months (baseline) and 12.2 ± 0.4 months post-HTx, as well as consecutive 3D-IVUS analyses up to 3 years post-HTx in 35 of the 42 recipients. Donor-transmitted atherosclerosis was defined as a maximal intimal thickness of 0.5 mm or greater at baseline. Changes in volumetric IVUS parameters were compared in recipients with (DA group) and without DA (DA-free group) at baseline, 1 year, and 3 years post-HTx.ResultsDonor-transmitted atherosclerosis was observed in 57.1% of 42 recipients. The DA group exhibited a significantly greater increase in plaque volume at 1 year post-HTx (P < 0.001), leading to increased percent plaque volume (plaque volume/vessel volume, [%]) (P < 0.001) and decreased luminal volume (P = 0.021). Donor-transmitted atherosclerosis was independently associated with a greater increase in percent plaque volume during the first post-HTx year (P = 0.011). From 1 to 3 years post-HTx, the DA group underwent continuous reduction in luminal volume (P = 0.022). These changes resulted in a higher incidence of angiographic CAV at 3 years post-HTx in the DA group (58.8% vs 5.6%, P = 0.002).ConclusionsThis volumetric IVUS study suggests that DA correlates with the worsening change in CAV several years post-HTx. Donor-transmitted atherosclerosis recipients may require more aggressive treatment to prevent subsequent CAV progression.

Coronary artery disease in heart transplantation: new concepts for an old disease

“…Donor age, when analyzed, is consistently reported to be associated with CAV detection []. This concept is not novel and is mainly related to the risk of transmission of donor coronary lesions to the recipient, as also suggested by studies finding that male donors – more likely to bear subclinical coronary lesions – may be associated with CAV development .…”

Variability in donor selection among pediatric heart transplant providers: Results from an international survey

“…Despite this, many pediatric centers reported much lower age cutoffs for adolescent recipients. While extension of this age cutoff may be warranted, concerns about the possibility of donor transmitted atherosclerosis and the potential association with allograft vasculopathy may continue to dissuade utilization of these organs in pediatric recipients.…”

Survival, graft function, and incidence of allograft vasculopathy in heart transplant patients receiving adverse risk profile donor hearts

“…Even though survival was not affected by donor age in the present study, we found high donor age to be a significant risk factor for CAV development. 24 Furthermore, patients with CAV are often switched to everolimus-based immunosuppression and may be subjected to closer graft function, rejection, and HLA antibody monitoring than patients without CAV. [21][22][23] According to the ISHLT registry, CAV affects 8% of survivors within the first year, 30% within 5 years, and 50% within 10 years after HTx.…”

“…The latter is known to have a different impact on prognosis than true CAV. 24 Furthermore, patients with CAV are often switched to everolimus-based immunosuppression and may be subjected to closer graft function, rejection, and HLA antibody monitoring than patients without CAV. These are all factors that could explain our findings.…”