ARE HEART-LUNG TRANSPLANT RECIPIENTS PROTECTED FROM DEVELOPING TRANSPLANT CORONARY-ARTERY DISEASE - A CASE-MATCHED INTRACORONARY ULTRASOUNDSTUDY

Background Accelerated coronary artery disease is a major cause of mor tality in heart transplant recipients; however, it does not appear to play a major role in the clinical outcome of heart-lung transplant rec ipients. The purpose of this study was to determine whether the incide nce and severity of transplant coronary artery disease as detected by intracoronary ultrasound in heart-lung transplant recipients are less than those encountered in heart transplant recipients. Methods and Res ults We studied the left anterior descending coronary artery with the use of intracoronary ultrasound imaging in 22 heart-lung transplant re cipients at the time of their routine annual coronary angiogram. Twent y-two heart transplant recipients were case matched for number of year s after transplant at ultrasound study, recipient age, donor age, and diagnosis of nonischemic cardiomyopathy. Mean intimal area, intimal in dex, Stanford class, and incidence of at least moderate disease (Stanf ord class greater than or equal to 3) were measured and calculated in each group and then compared between the two groups. Mean intimal area (1.6 +/- 2.5 versus 3.8 +/- 2.8 mm(2)), mean intimal index (0.07 +/- 0.10 versus 0.22 +/- 0.14), mean Stanford class (1.7 +/- 1.0 versus 2. 7 +/- 1.2), and incidence of Stanford class greater than or equal to 3 (14% versus 45%) were significantly lower in the heart-lung transplan t recipient group. Conclusions The incidence and severity of transplan t coronary artery disease are much less in patients receiving heart-lu ng transplants than in those receiving heart transplants alone.