| OBJECTIVE:Cardiac allograft vasculopathy(CAV)remains a serious long-term complication after heart transplantation(HTx).The aim of this study was to assess the incidence of CAV in our country and possible risk factors.METHODS:Between June 2004 and April 2017,670 patients underwent heart transplants at our institution.25 perioperative death patients,4 non-CAV retransplant patients,27 renal insufficiency patients and 89 patients who without any coronary angiography(CTA)at follow up were excluded from the study cohort.Consequently,A total of 525 patients were included in the study.CAV is defined as any stenosis of coronary artery by CTA or Coronary Arteriography(CAG).According to the International Society of Heart and Lung Transplantation(ISHLT)classification standard,it is divided into CAVO grade,CAV1 grade(mild),CAV2 grade(moderate),and CAV3 grade(severe).Patients in our center underwent CTA to find donor coronary artery disease in the first month after heart transplantation,and CTA or CAG was screened for CAV at 1,3,5,7,and 10 years at follow up.The risk factors of CAV reported in the ISHLT annual report and literature were included in the regression analysis.Statin has been administrated to every patient after surgery.RESULTS:After a mean follow-up of 65.8±40.7 months,22 patients developed CAV.CAV frequency was 0.2%at 1 year,1.2%at 3year,2.7%at 5 year,4%at 7year and 10.4%at 10 years.Among the 22 CAV positive patients,8 patients died,of which 6 were CAV3 grade,2 were CAV2 grade,the mean follow-up time was 42.3±26.7 months after diagnosis of CAV;14 patients survived were followed up for 50.9± 19.8 months after diagnosis of CAV.The incidence of CAV was higher in patients with high postoperative total cholesterol,irregular statins use,and more postoperative smoking(12.1%vs 2.5%,P<0.01),(15.4%vs 3.0%),P=0.002),(20.0%vs 2.8%,P<0.01).CAV-positive group has higher mean postoperative total cholesterol(5.76± 1.02 vs 4.91±1.37,P=0.004),and more preoperative smoking history(68.2%vs 31.8%,P=0.05).The incidence of CAV was lower in patients receiving tacrolimus when compared with cyclosporin(2.1%vs 6.0%,P=0.024)and n patients receiving mycophenolate mofetil when compared with azathioprine(3.7%vs 16.7%,P=0.037).Donor features such as older donor age,donor male sex and longer cold ischemia time failed to reach significance.Patients age,gender,body mass index(BMI),preoperative peripheral vascular disease,preoperative diabetes history,postoperative glycosylated hemoglobin level,and the heart disease that was the reason for heart transplant were not significantly different.Preoperative group reactive antibody(PRA),postoperative PRA,postoperative acute cell rejection in the first 1 post-HTx year and human leukocyte antigen(HLA)site mismatch did not reach statistical significance(P>0.5).In the regression multivariate analysis,independent variables associated with the development of CAV were postoperative smoking history(hazard ratio[HR],4.957;95%confidence interval[CI],1.718-14.296,P=0.003),the irregular use of statins(HR,4.273;95%CI,1.736-10.517,P=0.002),and the use of cyclosporin(HR,2.748;95%CI,1.010-17.474;P=0.048).Conclusion:Higher postoperative total cholesterol and postoperative smoking history are related to the occurrence of CAV.Postoperative adherence to statins use can reduce the occurrence of CAV.The choice of immunosuppressive agents may also affect the development of CAV. |
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