SPC365

Keeping track of cardiac allograft vasculopathy in the 21st century – a single-center experience

Session: Comunicações Orais - Sessão 14 - Transplante cardíaco
Speaker: Mariana Sousa Paiva

Congress: CPC 2023
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.8 Cardiovascular Surgery - Transplantation
Session Type: Comunicações Orais
FP Number: ---
Authors: Mariana Sousa Paiva; Sérgio Maltês; Christopher Strong; Daniel A. Gomes; Rita Reis Santos; Rita Bello; Bruno Rocha; Catarina Brízido; António Tralhão; Carlos Aguiar; Miguel Mendes

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>:</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Cardiac allograft vasculopathy (CAV) remains one of the major determinants of long-term morbidity and mortality associated with orthotopic heart transplantation (OHT). </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The aim of our study is to describe the incidence of CAV in a cohort of OHT recipients and to identify CAV predictors. </span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Single-center retrospective cohort including consecutive OHT patients who underwent CAV screening either by invasive coronary angiography (ICA) or coronary CT angiography (CCTA) from 2000-2021. </span>CAV was classified according to International Society for Heart and Lung Transplantation (ISHLT) nomenclature. <span style="color:black">Cox regression analysis was performed to explore the association between clinical variables and CAV development.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Overall, 88 patients (mean age 46&plusmn;14 years at the time of OHT, 72% men, 24 patients (27%) with previous ischemic cardiomyopathy) were included. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The mean donor age was 32&plusmn;12 years and the mean cold ischemia time was 156&plusmn;46 min. The baseline immunosuppressive scheme included prednisolone in all patients, mofetil mycophenolate in 81 (92%), tacrolimus in 44 (50%), cyclosporin in 41 (47%) and mTOR inhibitors (mTORi) in 8 (9%).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">After OHT, 67 (76%) developed hypertension and 36 (41%) diabetes. Most (89%) were under statin therapy. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">During the first year, 19 (22%) patients experienced acute &ge;2R cellular or humoral rejection. Furthermore, 12 patients (14%) developed donor-specific antibodies during follow-up. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">A total of 8 patients had documented CMV infection after OHT.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">During a median follow-up of 11 years (IQR 5-17), 44 (50%) patients developed ISHLT defined CAV <span style="color:#4472c4">&ndash; fig. 1: </span>CAV1 in 31 (35%) patients, CAV2 in 5 (6%) and CAV3 in 8 (9%). All CAV patients were started on aspirin therapy; 14 initiated mTORi; 5 underwent coronary angioplasty; and 1 patient underwent re-transplantation. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The only CAV predictor in our cohort was donor age (HR 1.05, 95% CI 1.01-1.083, p=0.012).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Over 20 years, there were 20 deaths (23%), of whom 5 (6%) were directly related with CAV.</span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>:</span></span></p>

<p><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Over a median follow-up of 11 years, half of our OHT cohort developed at least mild CAV, culminating in one re-transplant and five CAV-related deaths. Donor age was a predictor of CAV. These findings highlight the importance of preventive measures and systematic CAV screening in OHT recipients.</span></span></p>