INFLUENCE OF GRAFT-REJECTION ON INCIDENCE OF ACCELERATED GRAFT CORONARY-ARTERY DISEASE - A NEW APPROACH TO ANALYSIS

Conflicting data exist on the role of graft rejection as a risk factor for later development of accelerated graft coronary artery disease. W e analyzed 126 consecutive heart transplant recipients treated with cy closporine-based immunosuppressive regimens and devised an arbitrary m ethod to incorporate the number, duration, and severity of myocardial rejection episodes during the first postoperative year, resulting in a rejection score for each patient. We then correlated the later incide nce (mean follow-up, 4 years) of angiographic accelerated graft corona ry artery disease with this rejection score and with its components: n umber, duration, and severity of rejection; number and duration of unt reated rejection; and incidence and duration of delayed rejection ther apy. Accelerated graft coronary artery disease developed in 60 patient s (48%). The rejection score was 96.7 for patients in the ''no acceler ated graft coronary artery disease'' group and 110.4 for those in the ''accelerated graft coronary artery disease'' group (p = NS). No signi ficant difference was noted between patients with and without disease in any of the other seven rejection parameters analyzed, and no signif icant difference in time to occurrence of disease was noted between gr oups divided at the median rejection score. Donor age was older and fa sting triglyceride blood level was higher in patients with accelerated graft coronary artery disease than in those without disease. All othe r clinical characteristics, including HLA mismatches, ischemic time, b lood pressure, lipid profile, and drug therapy, did not differ between the two groups. Incidence of angiographically detectable accelerated graft coronary artery disease is not correlated with traditionally dia gnosed myocardial rejection during the first year when it is quantitat ed according to the method we devised, despite taking into account dur ation and severity as additional parameters. Accelerated graft coronar y artery disease may involve different or additional mechanisms than t he cell-mediated immune response as seen on endomyocardial biopsy.