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J Thorac Cardiovasc Surg 1995;109:1081-1089
© 1995 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

Cardiac transplant coronary artery disease: A multivariable analysisof pretransplantation risk factors for disease development and morbid events

Birmingham, Ala.

From the Division of Cardiothoracic Surgery, Department of Surgery,^a and the Division of Cardiology, Department of Medicine,^bUniversity of Alabama at Birmingham, Birmingham, Ala.

Address for reprints: David C. McGiffin, MD, Associate Professorof Surgery, University of Alabama at Birmingham, Birmingham, AL 35294.

Abstract

Coronary artery disease after cardiac transplantationis a major obstacle to long-term survival. The development and progressionof coronary artery disease after cardiac transplantation was analyzed in 217consecutive patients undergoing transplantation. The actuarial freedom fromany coronary artery disease (by angiography or autopsy) was 81% at 2 yearsand 20% at 8 years after transplantation. Coronary artery disease was moreprevalent in male than female patients (30% versus 50% free of coronary arterydisease at 5 years, p = 0.01). By multivariable analysis, pretransplantationrisk factors identified for coronary artery disease included pretransplantationpositive cytomegalovirus serologic status of the recipient (p = 0.002) and older donor age (p= 0.07). Progression of coronary artery disease was variable in both timeof onset and rate. Earlier detection did not result in more rapid progression.Coronary events severe enough for retransplantation (n = 8) and/or death from coronary artery disease (n = 9) occurred in 15 patients, of whom four underwent retransplantation.The actuarial freedom from coronary events was 88% at 5 years and 79% at 8years. By multivariable analysis, only male recipient (p = 0.05) was a risk factor for coronary events. Seven of the 15patients (47%) with coronary events died suddenly of coronary artery diseasewithout prior angiographic evidence of severe coronary disease. Coronary arterydisease is progressive. Improved surveillance methods are required to detectthe disease and institute timely intervention to prevent the occurrence ofunanticipated death. (J THORAC CARDIOVASC SURG 1995;109:1081-9)

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