Factors increasing the risk of allograft vascular disease in heart transplant recipients

Eloisa Arbustini, Barbara Dal Bello, Patrizia Morbini, Catherine Klersy, Maurizia Grasso, Marta Diegoli, Antonello Gavazzi, Carlo Campana, Paolo Grossi, Carlo Pellegrini, Luigi Martinelli, Gianbattista Ippoliti, Giuseppe Specchia, Mario Viganö

Research output: Contribution to journalArticlepeer-review

Abstract

Allograft vascular disease is the major cause of late cardiac graft failure. A multifactorial etiopathogenesis is supposed. Our study investigated factors associated with allograft vascular disease occurrence. After stratifying our series on the basis of potential risk factors, we calculated allograft vascular disease incidence rate in 267 grafts from 258 patients who underwent transplant between November 1985 and August 1996. Chi- square test was used for the identification of univariate risk factors to be included in a multivariate model. Multivariate analysis was based on a Poisson model. Seventy of the 267 grafts (26.2%) were diagnosed with allograft vascular disease. Heart disease other than idiopathic dilated cardiomyopathy, donor's age, number of mismatches for HLA-B = 2, presence of systo-diastolic hypertension, number of acute rejection positive endomyocardial biopsies ≤ 7 and the association of human Cytomegalovirus and hepatitis C virus infections proved to be univariate risk factors, and were included in the Poisson multivariate model. The association of Cytomegalovirus and hepatitis C infections multiplied allograft vascular disease incidence rate by 3.9, systo-diastolic hypertension by 2.2, occurrence of 2 HLA-B mismatches by 2, a high number (≤ 7) of acute rejection positive-endomyocardial biopsies by 1.8, and heart disease other than idiopathic dilated cardiomyopathy by 1.8. The association of human Cytomegalovirus and hepatitis C virus infections, of HLA-B mismatches, of acute rejection-positive endomyocardial biopsies, as well as post- transplantation hypertension and native heart disease other than idiopathic dilated cardiomyopathy, proved to be positively associated with an increased risk of allograft vascular disease. Given the concordance of our data with those of numerous prior series, we are going to adopt a special surveillance angiographic protocol for patients with these factors.

Original languageEnglish
Pages (from-to)985-999
Number of pages15
JournalGiornale Italiano di Cardiologia
Volume27
Issue number10
Publication statusPublished - Oct 1997

Keywords

  • Allograft vascular disease
  • Heart transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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