PROSPECTIVE EVALUATION OF PERIPHERAL VASCULAR-DISEASE IN HEART-TRANSPLANT RECIPIENTS

Purpose: Retrospective reviews suggest that the progression of periphe ral vascular disease (PVD) may be accelerated in heart transplant reci pients. This study was undertaken to determine the incidence and to id entify those risk factors that may be associated with the development or progression of PVD in these patients. Methods: Between January 1990 and December 1993 a prospective vascular screening protocol including abdominal ultrasonography, Doppler-derived ankle-brachial pressure in dexes (ABI), and carotid artery duplex imaging was added to the routin e preoperative and annual postoperative evaluation of 239 heart transp lant recipients. Results: Thirty-one significant vascular lesions were detected in 10% (24 of 239) of patients 52 +/- 9 years of age at a me an of 3.2 years after transplant; The distribution of lesions included carotid artery stenosis (11), femoropopliteal occlusive disease (10), aortoiliac occlusive disease (five), aortic aneurysm (four), and rena l artery stenosis in one patient. Revascularization procedures were pe rformed in 12 (50%) patients (carotid endarterectomy (four), aortobife moral bypass grafting (three), abdominal aortic aneurysm repair (two), transluminal angioplasty (two), splenorenal bypass (one), and femorot ibial bypass grafting (one)). One patient with diabetes mellitus (DM) was found to have noncompressible vessels during pretransplant evaluat ion. An additional 26 patients (11%), seven with DM, had noncompressib le vessels in the lower extremities during the follow-up period. Logis tic regression analysis revealed that the development of posttransplan t PVD was associated with smoking (p < 0.05) and ischemic cardiomyopat hy as an indication for transplantation (p < 0.05). The development of noncompressible vessels was associated with younger age (p < 0.05) an d the presence of diabetes (p < 0.05). Conclusion: Posttransplant peri pheral vascular disease occurred in 10% of heart transplant recipients and is associated with pretransplant ischemic cardiomyopathy and smok ing. A previously unrecognized subgroup of patients who have noncompre ssible vessels after operation is described. If the long-term survival of the heart transplant recipient is to be improved, routine follow-u p to identify and treat those patients at greater risk appears justifi ed.