Abstract 13297: Temporal Changes in Management of Heart Transplant Recipients and Impact on Coronary Allograft Vasculopathy
Background: The progression of coronary allograft vasculopathy (CAV) portends an adverse clinical outcome in heart transplant recipients. It is unknown whether temporal changes in the medical treatment following heart transplantation have resulted in less progression of CAV.
Methods: Serial intravascular ultrasonography was performed in 76 heart transplant recipients following transplantation and at 1-year follow-up between 1999 and 2007. Patients transplanted between 1999-2002 (n=34) and 2003-2007 (n=42) were compared with regard to patient demographics, medications, risk factor control and disease progression.
Results: Later transplanted patients were more likely to be cytomegalovirus (CMV) seropositive (19 v 0%, p=0.007) and received hearts from donors with a greater body mass index (27.5 v 25.4 kg/m2, p=0.03) and smoking history (17 v 0%, p=0.02). A greater use of statins (95 v 39%, p<0.001), mycophenolate (81 v 18%, p<0.001) and tacrolimus (31 v 9%, p=0.02) at baseline, and statins (100 v 52%, p<0.001) and mycophenolate (88 v 36%, p<0.001) at follow-up was observed in later transplanted patients. This was associated with lower achieved levels of LDL-C (82.3 v 99.8 mg/dL, p<0.001) and triglycerides (137.8 v 179.2 mg/dL, p=0.004) at follow-up. (Table) While no difference in the change in maximum intimal thickness was demonstrated between earlier and later transplanted patients, a greater increase in percent atheroma volume (PAV) and decrease in lumen volume was observed in later transplanted patients. This was further illustrated by a greater percentage of later transplanted patients undergoing substantial disease progression ([[Unable to Display Character: ∆]]PAV>5%).
Conclusion: Despite more aggressive medical treatment and lowering of atherogenic lipids, CMV seropositivity and donor risk factors were associated with more progression of CAV in more recently transplanted patients. This supports the need to develop more effective treatment strategies to prevent vasculopathy.
- © 2012 by American Heart Association, Inc.