Cardiac Allograft Vasculopathy in Redo-transplants: Is it More or Less the Same the Second Time Around?

Authors

  • Lauren McCreath Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Michael J Bonios Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Antigone Koliopoulou Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Omar Wever-Pinzon Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Spencer Wright Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Rami Alharethi Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Stephen H McKellar Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Greg Snow Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Bruce B Reid Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Katerina Skedros Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Anya Ragnhildstveit Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Jose Nativi Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Abdallah G Kfoury Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US
  • Stavros G Drakos Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, US

Keywords:

Cardiac allograft vasculopathy, heart transplant, coronary angiography, immunosuppression

Abstract

Purpose: Cardiac allograft vasculopathy (CAV) continues to hinder the long-term success of heart transplant recipients.  Redo-transplantation is currently the only definitive treatment for advanced CAV. We examined whether these patients are at similar CAV-risk with the second transplant

Methods: Heart recipients from 1985 to 2011 at the UTAH program were included in the study and those with CAV as an indication for redo-transplantation were identified. CAV diagnosis was made by coronary angiography and based on the 2010 ISHLT standardized nomenclature for CAV. Patient demographics, rejection history, and CAV incidence were analyzed. 

Results: Of the 1,169 eligible patients, 135 (11.5%) developed CAV post their first transplant; 78 cases within 10 years and 54 beyond 10 years. The mean time to CAV was 6.58 years. Of the 135 patients who developed CAV, only 21 (15.5%) ended up requiring a redo-transplant. Of the 21 retransplanted patients, 4 (19.0%) developed CAV again; 2 patients within 10 years and 2 patients beyond 10 years indicating a similar risk for CAV occurrence for first and redo-transplant. 

Conclusions: Our results indicate that CAV is as likely to develop in redo-transplants despite recent advances in immunosuppression and the standardized use of lipid-lowering agents. Although outcomes in redo-transplantation for the indication of CAV are favorable, efforts to better understand and minimize CAV are needed, especially in the face of scarce donor organs.

Downloads

Published

2018-01-14

Issue

Vol. 13 No. 1 (2018)

Section

Original Article

License

Authors who publish with this journal agree to the following terms:

a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).