(45) Influence of Donor Transmitted Coronary Artery Disease in Cardiac Allograft Vasculopathy: Results of the Donor Transmitted Coronary Artery Disease (DONOR-CAD) Study

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; p. S29
• Main Authors: Couto-Mallon, D., Donoso-Trenado, V., Barge-Caballero, E., Perez, F. Hernandez, García, J. López-Azor, Gardeta, T. Domingo, Castel, M.A., Perez, S. Mirabet, Bravo, I. Garrido, Diez-Lopez, C., Anton, R. Manrique, Granados, A. López, Muñiz, J., Crespo-Leiro, M.G.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.061

To evaluate the rate of development of cardiac allograft vasculopathy (CAV) after heart transplant (HT), risk factors and the relevance of donor transmitted coronary artery disease (DTCAD) in CAV progression (CAV-p).
Retrospective study of HT patients > 18-year-old between 2008-2018 in 11 centers from Spain who underwent coronary angiogram (c-angio) within the first 3 months post HT. Per protocol c-angio at baseline, one year and 5 years post-HT were evaluated by two-dimension Quantitative Coronary Analysis and interventional cardiologists. Angiographically significant coronary artery disease (s-CAD) was defined as stenosis ≥ 50% in main coronary arteries and non-significant (ns-CAD) as a stenosis <50%. CAV-p was defined as occurrence of s-CAD if previously was not documented or, if previous s-CAD, when new territories were affected. Comparison among CAV-p patients and non-CAV-p patients was done by chi-square and t-Student. Progression rate was calculated by competitive risks function and independent risk factors were identified by multivariable Cox regression.
937 patients were evaluated with basal c-angio and DTCAD was identified in 18.3% (significant DTCAD in 6.9%). CAV-p was found in 70 patients during a median follow-up of 6.3 years: (51 out of 791 patients at one-year and 19 out of 232 at 5 years). Donors of patients with CAV-p were older (49.2 years ± 11.1 vs 44.5 ± 12.5, p=0.001) and had diabetes more often (12.2% vs 4.1%, p=0.005). Patients with CAV-p received statins at baseline less frequently (51.4% vs 71.4%, p=0.001) and had more acute rejection (AR) within the first year (47.1% vs 24.8%, p<0.001). During follow-up, CAV-p rate was 3.85 per 100 patients-year (CI 95% 3.05-4.87). Progression rate was significantly higher among patients with significant DTCAD (9.65, CI 95% 5.35-17.43) and patients with ns- DTCAD (9.24, CI 95% 5.82-14.67) (p value Gray's test <0.001). Donor age (HR 1.03, CI 95% 1.00-1.06, p=0.02), AR within the first year (HR 1.9, CI 95% 1.12-3.32, p=0.018) and DTCAD (HR 2.74, CI 95% 1.38-5.44, p= 0.004) were independent predictors for CAV-p.
Development and/or progression rate of CAV on per protocol follow-up c-angios after HT was 3.85 per 100 patients-year. Risk of CAV-p is higher among patients with older donors, episodes of AR and DTCAD.