Risk Stratification for Cardiac Allograft Vasculopathy in Heart Transplant Recipients　– Annual Intravascular Ultrasound Evaluation –

Takuma Sato; Osamu Seguchi; Hatsue Ishibashi-Ueda; Masanobu Yanase; Norihiro Okada; Kensuke Kuroda; Eriko Hisamatsu; Haruki Sunami; Takuya Watanabe; Seiko Nakajima; Kyoichi Wada; Hiroki Hata; Tomoyuki Fujita; Norihide Fukushima; Junjiro Kobayashi; Takeshi Nakatani

doi:10.1253/circj.CJ-15-1037

Cardiovascular Surgery

Risk Stratification for Cardiac Allograft Vasculopathy in Heart Transplant Recipients　– Annual Intravascular Ultrasound Evaluation –

Takuma Sato, Osamu Seguchi, Hatsue Ishibashi-Ueda, Masanobu Yanase, Norihiro Okada, Kensuke Kuroda, Eriko Hisamatsu, Haruki Sunami, Takuya Watanabe, Seiko Nakajima, Kyoichi Wada, Hiroki Hata, Tomoyuki Fujita, Norihide Fukushima, Junjiro Kobayashi, Takeshi Nakatani

Author information

Takuma Sato
Department of Transplantation, National Cerebral and Cardiovascular Center
Osamu Seguchi
Department of Transplantation, National Cerebral and Cardiovascular Center
Hatsue Ishibashi-Ueda
Department of Pathology, National Cerebral and Cardiovascular Center
Masanobu Yanase
Department of Transplantation, National Cerebral and Cardiovascular Center
Norihiro Okada
Department of Transplantation, National Cerebral and Cardiovascular Center
Kensuke Kuroda
Department of Transplantation, National Cerebral and Cardiovascular Center
Eriko Hisamatsu
Department of Transplantation, National Cerebral and Cardiovascular Center
Haruki Sunami
Department of Transplantation, National Cerebral and Cardiovascular Center
Takuya Watanabe
Department of Transplantation, National Cerebral and Cardiovascular Center
Seiko Nakajima
Department of Transplantation, National Cerebral and Cardiovascular Center
Kyoichi Wada
Department of Pharmacy, National Cerebral and Cardiovascular Center
Hiroki Hata
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
Tomoyuki Fujita
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
Norihide Fukushima
Department of Transplantation, National Cerebral and Cardiovascular Center
Junjiro Kobayashi
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
Takeshi Nakatani
Department of Transplantation, National Cerebral and Cardiovascular Center

Keywords: Acute cellular rejection, Cardiac allograft vasculopathy, Donor age, Heart transplantation, Intravascular ultrasound

JOURNAL FREE ACCESS FULL-TEXT HTML

2016 Volume 80 Issue 2 Pages 395-403

DOI https://doi.org/10.1253/circj.CJ-15-1037

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Abstract

Background:Cardiac allograft vasculopathy (CAV) limits long-term success after heart transplant. We assessed the post-transplant risk factors for CAV development.Methods and Results:Patients who underwent heart transplant between May 1999 and December 2013 were included in this study. Patients (n=54) were divided into 2 groups according to the presence or absence of CAV progression after transplant. Coronary angiogram and intravascular ultrasound were conducted within 5–11 weeks after transplant, at 12 months, and annually thereafter. Scheduled endomyocardial biopsies were performed after transplant or whenever acute cellular rejection (ACR) or antibody-mediated rejection was suspected. Twenty-five of 54 patients (46.2%) had CAV progression. ACR ≥International Society for Heart and Lung Transplantation grade 2 (ACR ≥2) and donor age >50 years were significantly associated with CAV development compared with ACR <2 and donor age <50 years. Patients with no history of ACR ≥2 and donor age ≤50 years had a significantly low risk of developing CAV compared with the other groups.Conclusions:Donor age and history of ACR ≥2 are independent risk factors for CAV development. Identifying patients at risk of developing CAV is important for appropriate direction of resources and intensity of follow-up. (Circ J 2016; 80: 395–403)

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