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Is pre-transplant vascular disease a risk factor for mortality and morbidity after heart transplantation?

Is pre-transplant vascular disease a risk factor for mortality and morbidity after heart transplantation?,Hiroo Takayama,Avery B. Nathens,Heather Merr

Is pre-transplant vascular disease a risk factor for mortality and morbidity after heart transplantation?   (Citations: 1)
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Background: Severe vascular disease is a relative contraindication to heart transplantation (HTx). We addressed the effect of vascular disease on HTx outcomes.Methods:This is a nonconcurrent cohort study of 402 patients who received HTx at our institution between 1985 and 2004. Pre- transplant vascular evaluation included carotid, lower extremity, and renal artery duplex studies, and CTangiogram when indicated. Patients with severe and nontreatable vascular disease were excluded. Patients were divided into Group 1: those with pre-transplant vasculopathy, and Group 2: those without pre-transplant vasculopathy. Group 1 had 24 patients with 25 vascular lesions: 1 aortic dissection, 2 abdominal aortic aneurysm (AAA)'s, 5 carotid artery stenoses, 1 renal artery stenosis, and 16 peripheral vascular lesions. Interventions were performed to 15 lesions prior to HTx and to 2 lesions after HTx.Results:Median follow-up was 5.5 years. Group 1 had higher incidence of ischemic cardiomyopathy (p < 0.001), hypertension (p = 0.028), chronic obstructive pulmonary disease (COPD) (p = 0.004), and smoking history (p < 0.001). There were no differences in sex, hyperlipidemia, diabetes, stroke, or renal dysfunction. Multivariate analysis revealed odds of post-transplant death in Group 1 was 1.4 (95% CI: 0.48—4.1, p = 0.54) times greater than that in Group 2. Cox proportional hazards model for survival showed a 50% increase in the hazard of death in patients with pre-transplant vasculopathy, but without statistical significance. Group 1 had higher incidence of post-transplant stroke (p = 0.001) but no difference in allograft coronary atherosclerosis. Conclusions: Pre-transplant vascular disease seems to have negative effect on outcomes after HTx. Larger scale study is needed for further evaluation. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Published in 2010.
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