The Canadian study of cardiac transplantation atherosclerosis

OBJECTIVES: To describe risk factors associated with the development of tra nsplantation coronary artery disease (TCAD). DESIGN: A retrospective study of the Canadian experience. PATIENTS: Seven hundred and nineteen patients with follow-up of at least 12 months following transplantation and a minimum of one coronary angiogram w ere analyzed. RESULTS: Two hundred and fourteen patients (30%) developed angiographic evi dence of TCAD during an average follow-up of 50+/-25 months. Actuarial free dom rate from TCAD averaged 60%, and survival averaged 85% five years follo wing transplantation. Abnormal coronary angiograms increased from 11% to 40 % between the first and the fifth year following transplantation. The Cox m ultivariate final model showed that recipients of donor hearts of 50 years and older (RR 4.35, 95% CI 2.32 to 8.15), patients with two or more episode s of acute rejection (RR 1.56, 95% CI 1.11 to 2.21) and patients with a dia gnosis of ischemic cardiomyopathy before transplantation (RR 1.38, 95% CI 1 .03 to 1.84) were at higher risk of TCAD. The same risk factors also had a significant effect. on survival, although patients who were administered a hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor duri ng follow-up had a higher survival rate (95% versus 85%, P=0.01) five years following heart transplantation. CONCLUSIONS: Recipients of hearts from older donors, patients with an ische mic heart disease before transplantation and those with several episodes of acute rejection are at increased risk for TCAD. Patients who are administe red an HMG-CoA reductase inhibitor during follow-up have a higher survival rate five years following transplantation.