Risk factors for development of accelerated coronary artery disease in cardiac transplant recipients

Abstract

Allograft coronary artery disease (CAD) is the major determinant of long-term survival following heart transplantation (HTx). In a group of 210 heart transplant recipients, we diagnosed CAD in 54 (27.1%) by coronary angiography, postmortem examination or examination of the transplanted heart at the time of retransplantation. Retrospective analysis of potential risk factors for the development of CAD was performed for both immunological (rejection pattern, immunosuppressive therapy, cytomegalovirus [CMV] infection), and nonimmunological (hyperlipidemia, smoking, hypertension, diabetes mellitus, obesity) risk factors. The total number of rejection episodes correlated significantly with the occurrence of CAD (P less than 0.05), showing that patients who experienced two or more rejection episodes had an incidence of CAD of 40%, as opposed to a 23% incidence in patients who experienced no rejection. A composite rejection score derived from multivariate regression analysis of the severity, frequency, and timing of acute cardiac rejection episodes was found to correlate with the development of CAD (P less than 0.05). Postoperative arterial hypertension also correlated significantly with the onset of CAD (P less than 0.01), with a 92.6% incidence of hypertension in the group with CAD versus 76.3% in the group without CAD. Smoking after transplantation correlated significantly with the occurrence of CAD (P less than 0.05). There was no significant correlation with other analyzed factors in this group of patients. In this review, the development of CAD after heart transplantation correlated with treated allograft rejection. Aggressive treatment of hypertension and cessation of smoking may contribute to alleviation of this serious complication.

Analysis of the risk factors for allograft vasculopathy in asymptomatic patients after cardiac transplantation

“…Uretsky et al 15 have found a relation between allograft vasculopathy and the occurrence of two or more rejection episodes. These data were corroborated by Radovancevic et al 20 when they analyzed the experience of the Texas Heart Institute; these results, however, were not confirmed by data of other study groups such as the one by Gao et al 21 at Stanford University. In the present series, we have found no statistically significant difference between the group with allograft vasculopathy and the group with a normal coronary angiography in regard to the number of rejection episodes.…”

Cardiomyocyte and Heart Failure

“…Therefore for this population, weight loss should be mandatory before listing for HT. Other comorbidity includes cirrhosis, peripheral vascular disease, addictions (tabacco, excessive alcohol) [52]. Psychosocial evaluation is mandatory before listing-up for HT.…”

“…CRT also has led to a degree of improvement in left ventricular volume and EF in patients with mild heart failure similar to that in patients with severe heart failure [34]. CRT reduced mortality and hospitalizations among asymptomatic or mildly symptomatic heart failure patients [52]. Hence, recent clinical trials are directed toward focus on delaying progression of heart failure in asymptomatic or less symptomatic patients.…”

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

“…Corticosteroids and CNIs are the cornerstone of immunosuppressive therapy in heart transplant recipients [108][109][110]. These immunosuppressive agents used in routine post cardiac transplant care have deleterious effects on blood pressure [104,[109][110][111]. Introduction of CNIs shifted the paradigm of solid organ transplant.…”

“…Post-transplant hypertension plays a significant role in the onset of angiographic CAV. Hypertension in cardiac transplant recipients is multifactorial and various mechanisms are implicated in the genesis of hypertension [102][103][104][105][106][107]. The pathogenesis of hypertension in heart transplant recipients is multifactorial and complex.…”