MYOCARDIAL FIBRIN DEPOSITS IN THE FIRST MONTH AFTER TRANSPLANTATION PREDICT SUBSEQUENT CORONARY-ARTERY DISEASE AND GRAFT FAILURE IN CARDIACALLOGRAFT RECIPIENTS

PURPOSE: To determine whether fibrin deposition during the first month following cardiac transplantation predicts development of coronary ar tery disease and graft failure in cardiac allograft recipients. PATIEN TS AND METHODS: We prospectively studied 121 consecutive adult patient s who received cardiac transplants between 1988 and 1995. Serial endom yocardial biopsies obtained during the first month posttransplant (2.3 + 0.6 biopsies/patient) were studied immunohistochemically for fibrin deposits. Patients were followed up with annual angiograms (3.2 + 1.7 / patient) evaluated with side-by side comparisons for the presence an d progression of coronary artery disease. RESULTS: All pretransplant b iopsies were fibrin-negative; 60 allografts (50%) remained without fib rin, and 61 (50%) contained fibrin during the first posttransplant mon th. Of allografts with fibrin, 72% developed coronary artery disease, while 27% of allografts without fibrin developed the disease (P <0.001 ). Coronary artery disease was progressive in 61% of allografts with f rbrin, and in 25% of allografts without fibrin (P <0.001). Graft failu re was more frequent and time-to-graft-failure occurred earlier in pat ients whose allografts had fibrin during the first month after transpl antation (P <0.001). CONCLUSIONS: Fibrin in biopsies during the first month after transplantation identifies patients at high risk for devel oping coronary artery disease or graft failure, thereby allowing the o pportunity to initiate preventive procedures. (C) 1998 by Excerpta Med ica, Inc.