CORRELATION OF DONOR CHARACTERISTICS WITH TRANSPLANT CORONARY-ARTERY DISEASE AS ASSESSED BY INTRACORONARY ULTRASOUND AND CORONARY ANGIOGRAPHY

The mechanisms responsible for transplant coronary artery disease (CAD ) and its predisposing factors remain incompletely understood. The inf luence of donor characteristics as predisposing factors has not been s tudied systematically. We examined the correlation of donor demographi c, clinical, and immunologic parameters with transplant CAD assessed b y both intracoronary ultrasound (ICUS) and coronary angiography in 116 heart transplant recipients (age 44.7 +/- 12.0 years) studied 3.4 yea rs (range 1.0 to 14.6) offer transplantation, Quantitative ultrasound data were obtained calculating mean intimal thickness from several dis tinct coronary sites. Coronary angiograms were categorized visually as normal or showing any transplant CAD. By multivariate regression anal ysis, donor undersize of >20% of recipient weight (p <0.02) and durati on after transplantation (p <0.005) were independently correlated with the amount of ICUS intimal thickness (r = 0.36, p = 0.0007), and olde r donor age with angiographic evidence for the disease (r = 0.34; p <0 .006). In a subgroup analysis of the 39 patients studied 1 year after transplantation, white donor race (p <0.05), fewer human leukocyte ant igen-DR mismatches (p <0.002), shorter ischemic time time (p <0.04), a nd donor smoking history (p <0.02) were independent predictors for sev erity of ICUS intimal thickening (r = 0.92, p = 0.0009); higher donor age (p <0.006) and higher arterial partial pressure of oxygen (p <0.00 3) were independent predictors for angiographic disease (r = 0.67, p < 0.002). In conclusion, donor characteristics may contribute to the pro bably multifactorial pathogenesis of transplant CAD.