Allograft morphology and function in heart transplant recipients surviving more than 15 years by magnetic resonance imaging and dual-source computed tomography.

OBJECTIVE

Cardiac allograft vasculopathy and late graft failure are the main limiting factors of long-term success of heart transplantation, and little is known about graft function in the long-term survivors. The aim of this study was to assess the ventricular function and the allograft vasculopathy in long-term survivors (>15 years) with the cardiac magnetic resonance imaging (MRI) and dual-source computed tomography (DSCT) coronary angiogram.

METHODS

In our database, 34 cardiac recipients have more than 15 years of follow-up and were evaluated for this study; 22 (65%) of them were enrolled. Mean age at transplant was 46 ± 13.5 years, mean donor age was 28.5 ± 10.1 years, and mean graft ischemic time was 189 ± 58 min. Mean follow-up was 18.5 ± 2.4 years (range 15-22). All patients underwent cardiac MRI and DSCT.

RESULTS

Mean left ventricular (LV) volumes indexed to the body surface area (BSA) were within normal range: the end-diastolic volume/BSA was 61 ± 16 ml m(-2), end-systolic volume/BSA was 22 ± 15 ml m(-2), stroke volume/BSA was 38 ± 6 ml m(-2), LV mass/BSA: 72 ± 18 g m(-2), and mean ejection fraction (EF) was 0.59 ± 0.08. Two patients (9%) showed a global cardiac hypokinesia and two other patients (9%) showed akinesia of one segment. At DSCT, 41% of patients had a strictly normal coronary angiogram, 41% had wall thickening and 18% presented a least one >60% stenosis.

CONCLUSIONS

Cardiac MRI and DSCT coronary angiogram revealed a normal graft function and morphology after more than 15 years of transplantation. However, a certain number of patients have significant cardiac allograft vasculopathy and another consistent group has initial disease. These patients deserve further follow-up and tailoring of the immunosuppressive regimen.