Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
Transpl Int. 2021 Feb;34(2):281-289. doi: 10.1111/tri.13793. Epub 2020 Dec 19.
Cardiac allograft vasculopathy (CAV) is an important cause of late mortality after heart transplantation, which may be influenced by preexisting coronary disease (CAD) in the donor heart.
The aim of this study was to verify whether CAD in the donor heart had any influence on survival, cardiac-related adverse events (CRAEs), and coronary disease progression after transplantation. Donor coronary angiography performed in 289 hearts showed absence of CAD in 232 (no-CAD group) and moderate (≤50%) stenoses (CAD group) in 57. The 2 groups were compared for survival, freedom from CRAEs, and development of grade ≥ 2 CAV after transplantation.
Of 30-day mortality and postoperative complication rate was similar as mean follow-up (76 ± 56 and 75 ± 55 months) for no-CAD and CAD (P = 0.8). Ten-year actuarial survival was 58 ± 4% and 62 ± 7% for no-CAD and CAD (P = 0.4). Ten-year freedom from grade ≥ 2 CAV and from CRAEs was 81 ± 4% and 66 ± 5% vs 75 ± 8% and 67 ± 9% in no-CAD and CAD (P = 0.9 and 0.9, respectively).
Donor hearts with moderate CAD did not affect survival, freedom from CRAEs and did not accelerate development of high-grade CAV after transplantation supporting the use of such grafts to expand the donor pool. Routine use of coronary angiography in donor selection appears justified.
心脏同种异体移植血管病（CAV）是心脏移植后晚期死亡的一个重要原因，可能与供体心脏中的预先存在的冠状动脉疾病（CAD）有关。
本研究旨在验证供体心脏中的 CAD 是否对移植后的生存、心脏相关不良事件（CRAE）和冠状动脉疾病进展有任何影响。对 289 例心脏进行的供体冠状动脉造影显示 232 例无 CAD（无 CAD 组）和 57 例中度（≤50%）狭窄（CAD 组）。比较两组移植后的生存、无 CRAE 发生率和 2 级以上 CAV 的发展情况。
30 天死亡率和术后并发症发生率相似（无 CAD 组和 CAD 组分别为 76±56 个月和 75±55 个月，P=0.8）。无 CAD 和 CAD 的 10 年生存率分别为 58±4%和 62±7%（P=0.4）。无 CAD 和 CAD 的 10 年无 2 级以上 CAV 和 CRAE 发生率分别为 81±4%和 66±5%和 75±8%和 67±9%（P=0.9 和 0.9，分别）。
中度 CAD 的供体心脏不会影响移植后的生存、无 CRAE 发生率，也不会加速发展为高级别 CAV，支持使用此类移植物来扩大供体池。在供体选择中常规使用冠状动脉造影似乎是合理的。
