Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Germany.
Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Int J Cardiol. 2021 May 15;331:57-62. doi: 10.1016/j.ijcard.2021.02.002. Epub 2021 Feb 9.
Cardiac allograft vasculopathy (CAV) remains a major long-term complication in heart transplant (HT) recipients related to increased mortality. We aimed to identify non-immune recipient- and donor-related risk factors for the development of CAV in HT patients.
40,647 recipients, prospectively enrolled from April 1995 to January 2019 in the Organ Procurement and Transplantation Network (OPTN), were analyzed after exclusion of pediatric patients, those with missing information on CAV, and re-transplantation. Multivariable-adjusted Cox regression analyses were performed to identify recipient- and donor-related risk factors for CAV. 5-year population attributable risk for classical cardiovascular risk factors was calculated to estimate the recipients' CAV risk. Analyses were based on OPTN data (June 30, 2019).
Of 40,647 post-transplant patients, 14,698 (36.2%) developed CAV with a higher incidence in males (37.3%) than in females (32.6%) (p < 0.001). The mean follow-up time was 68.2 months. In recipients, male sex, African American and Asian ethnicity, ischemic cardiomyopathy, body mass index and smoking were associated with CAV occurrence. In donors, older age, male sex, smoking, diabetes and arterial hypertension were related to CAV. Results remained fairly stable after analysis of different time periods. 5-year attributable CAV risk for classical cardiovascular risk factors was 9.1%.
In this large registry with known limitations concerning data completeness, CAV incidence was higher in males than in females. Next to male sex and donor age, the classical cardiovascular risk factors were related to incident CAV. Classical cardiovascular risk factors played only a minor role for the 5-year attributable CAV risk.
心脏同种异体移植血管病（CAV）仍然是心脏移植（HT）受者的一个主要长期并发症，与死亡率增加有关。我们旨在确定与 CAV 发展相关的非免疫受者和供者相关的危险因素。
排除儿科患者、CAV 信息缺失和再次移植患者后，对 1995 年 4 月至 2019 年 1 月期间在器官获取和移植网络（OPTN）中前瞻性纳入的 40647 名受者进行分析。采用多变量调整 Cox 回归分析来确定 CAV 的受者和供者相关危险因素。计算经典心血管危险因素的 5 年人群归因风险，以估计受者的 CAV 风险。分析基于 OPTN 数据（2019 年 6 月 30 日）。
在 40647 名移植后患者中，有 14698 名（36.2%）发生 CAV，男性（37.3%）的发生率高于女性（32.6%）（p<0.001）。平均随访时间为 68.2 个月。在受者中，男性、非裔美国人、亚洲人、缺血性心肌病、体重指数和吸烟与 CAV 发生相关。在供者中，年龄较大、男性、吸烟、糖尿病和动脉高血压与 CAV 相关。在分析不同时间段后，结果仍然相当稳定。经典心血管危险因素导致 CAV 的 5 年归因风险为 9.1%。
在这个具有已知数据完整性局限性的大型注册研究中，男性的 CAV 发生率高于女性。除了男性和供者年龄外，经典心血管危险因素与 CAV 事件相关。经典心血管危险因素对 5 年归因 CAV 风险的作用较小。
