HEART-TRANSPLANT CORONARY-ARTERY DISEASE DETECTED BY CORONARY ANGIOGRAPHY - A MULTIINSTITUTIONAL STUDY OF PREOPERATIVE DONOR AND RECIPIENT RISK-FACTORS

Background: Controversy exists regarding donor and recipient factors t hat promote the development and progression of coronary artery disease after heart transplantation and the likelihood of coronary artery dis ease causing death or retransplantation. Methods: To investigate this issue in a large cohort of patients, we analyzed 5963 postoperative an giograms performed in 2609 of the 3837 patients undergoing heart trans plantation at 39 institutions between January 1990 and December 1994. Coronary artery disease was classified as mild, moderate, or severe on the basis of left main involvement, primary vessel stenoses, and bran ch stenoses. Coronary artery disease was considered severe if left mai n stenosis was > 70% or 2 or more primary vessels stenoses were > 70% or branch stenoses were > 70% in ail 3 systems. Results: By the end of 5 years after heart transplantation, coronary artery disease was pres ent in 42% of the patients, mild in 27%, moderate in 8%, and severe in 7%. Coronary artery disease-related events (death or retransplantatio n) had an actuarial incidence of 7% at 5 years and occurred in 2 of 3 of the patients with development of angiographically severe coronary a rtery disease. By multivariable logistic analysis, risk factors for do nor coronary artery disease included older donor age (P <.0001) and do nor hypertension (P =.0002). By multivariable analysis in the hazard f unction domain, risk factors identified for the earlier onset of allog raft coronary artery disease included older donor age (P <.0001), dono r male sex (P =.0006), donor hypertension (P =.07), recipient male sex (P =.02), and recipient black race (P =.01). The actuarial incidence of severe coronary artery disease was 9% at 5 years. Conclusions: Angi ographic coronary artery disease is very common after heart transplant ation, occurring in approximately 42% of the patients by 5 years. Olde r donor age, donor hypertension, and male donor or recipient predict e arlier onset of angiographic allograft coronary artery disease. Althou gh severe angiographic allograft coronary artery disease occurs in onl y 7% of the patients at 5 years, its presence is highly predictive of subsequent coronary artery disease-related events or retransplantation .