CORONARY ARTERIOPATHY AFTER HEART-TRANSPLANTATION

Purpose: To describe changes in the coronary artery following heart tr ansplantation (HTx) in patients who survived for 1 year or more. Mater ial and Methods: Yearly ventriculography and coronary angiography were performed in 171 out of 172 patients aged over 12 years who survived HTx in Norway for 1 year or more after the first operation in 1983. Me an follow-up was 5.2 years+/-2.8, range 1-12. Results: Altogether 31 p atients died in the follow-up period, 8 (26%) of them from coronary ar tery disease (CAD). Angiographic changes included coronary artery sten oses, diffuse changes with ectatic and narrowed segments of the major coronary vessels, peripheral changes with occlusions and tapering of t he small vessels, and reduction in the left ventricular ejection fract ion (EF). Significant stenosis developed in 43 patients and 19 of thes e developed an occlusion of one of the major coronary artery branches. The coronary arteries were without significant stenosis in 97% of the surviving 141 patients at 1 year after HTx and in 82% at 5 years. Com pletely normal findings were seen in 81% after 1 year and in 44% after 5 years. Progression to significant stenosis and occlusion was rapid once changes first appeared. Conclusion: CAD contributed to a signific ant number of deaths. The stenoses could develop at any time after tra nsplantation and usually progressed rapidly once the first changes app eared.