Impact of lipid abnormalities in development and progression of transplantcoronary disease: A serial intravascular ultrasound study

Objective We sought to determine the role of conventional atherosclerosis r isk factors in the development and progression of transplant coronary arter y disease (CAD) using serial intravascular ultrasound imaging. Background Transplant artery disease is a combination of allograft vasculop athy and donor atherosclerosis. The clinical determinants for each of these disease processes are not well characterized, Intravascular ultrasound ima ging is the most sensitive tool to serially study these processes. Methods Baseline intravascular ultrasound imaging was performed 0.9 +/- 0.5 months after transplantation to identify donor atherosclerosis. Follow-up imaging was performed at 1.0 +/- 0.07 year to evaluate progression of donor atherosclerosis and development of transplant vasculopathy. Conventional r isk factors for CAD included recipient age, gender, smoking history, diabet es mellitus, hypertension and hypercholesterolemia. Results Donor-transmitted atherosclerosis was present in 36 patients (39%). At follow-up, progression of donor lesions was seen in 15 patients (42%) a nd 42 patients (45%) developed transplant vasculopathy, leaving 35 patients (38%) without any disease. There was no difference in any conventional ris k factors in patients with and without allograft vasculopathy. However, the severity of allograft vasculopathy was associated with a larger increase i n low density lipoprotein (LDL) cholesterol from baseline (p = 0.02). High one-year post-transplant serum triglyceride level and pretransplant body ma ss index were the only significant predictors (p = 0.03) for progression of donor atherosclerosis. Conclusions Conventional atherosclerosis risk factors do not predict develo pment of allograft vasculopathy, but greater change in serum LDL cholestero l level during the first year after transplant is associated with more seve re vasculopathy. Therefore, maintenance of LDL cholesterol as close to pret ransplant values as possible may elp to limit the rate of progression of ac quired allograft vasculopathy. (J Am Coll Cardiol 2001;38:206-13) (C) 2001 by the American College of Cardiology.