Authors

• Marija Doronjga — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0009-0007-9361-6953
• Marijan Pašalić — University of Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3197-2190
• Maja Čikeš — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4772-5549
• Dora Fabijanović — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-2633-3439
• Nina Jakuš — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-7304-1127
• Hrvoje Jurin — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-2599-553X
• Daniel Lovrić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-5052-6559
• Vedran Pašara — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-6587-2315
• Ivo Planinc — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-0561-6704
• Jure Samardžić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-9346-6402
• Željko Čolak — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-0507-4714
• Joško Bulum — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-1482-6503
• Hrvoje Gašparović — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-2492-3702
• Davor Miličić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-9101-1570
• Boško Skorić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-5979-2346

Keywords

cardiac allograft vasculopathy, heart transplantation, endothelial injury

DOI

Full Text

**Introduction**: Cardiac allograft vasculopathy (CAV) remains a leading cause of late graft loss after heart transplantation (HTx) and results from complex immune- and non-immune-mediated pathways, each contributing to endothelial dysfunction. (1-3) **Patients and Methods**: We performed a retrospective registry-based analysis of HTx recipients who underwent CAV assessment by coronary angiography between January 2010 and January 2018 at the University Hospital Centre Zagreb. Baseline donor and recipient characteristics were collected, along with recipient clinical parameters at 1 and 3 years following HTx. The objective was to identify risk factors for CAV at 3 years. **Results**: Among 126 heart transplant recipients, CAV was present in 38 patients (30%) at 3 years; 25 (65.8%) were male. The CAV group had a higher mean donor age (46.7 ± 8.7 years). Recipient history of coronary artery disease (CAD) and donor age >45 years were independently associated with increased CAV risk. CAD history conferred a 3.6-fold higher risk (HR = 3.61, 95% CI: 1.59–8.22, p = 0.002), and donor age >45 was associated with a 3.7-fold increased risk (HR = 3.72, 95% CI: 1.64–8.45, p = 0.002) (**Figure 1**). No other baseline characteristics or recipient cardiovascular risk factors at 1 and 3 years were significantly different between groups (**Figures 2** and **3**Figure 3). FIGURE 1. Forest plot illustrating the association between baseline donor and recipient characteristics and detection of coronary allograft vasculopathy at 3 years. AMCS = acute mechanical circulatory support, BMI = body mass index, CAD = coronary artery disease, CAV = coronary allograft vasculopathy, CMV = cytomegalovirus, DMCS = durable mechanical circulatory support, eGFR = estimated Glomerular Filtration Rate, HDL = high-density lipoprotein, HTx = heart transplantation, LDL = low density lipoprotein, MCS = mechanical circulatory support, PRA = panel reactive antibodies, SD = standard deviation. FIGURE 2. Recipient 1-year characteristics based on ≥1 coronary allograft vasculopathy at 3 years. ACEi = angiotensin-converting enzyme inhibitor, ARB = angiotensin II receptor blockers, CCB = calcium channel blocker, CyA = cyclosporine, eGFR = estimated Glomerular Filtration Rate, HDL = high-density lipoprotein, DL = low-density lipoprotein, MMP = mycophenolate mofetil. FIGURE 3. Recipient 3-year characteristics based on ≥1 coronary allograft vasculopathy at 3 years. ACEi = angiotensin-converting enzyme inhibitor, ARB = angiotensin II receptor blockers, CCB = calcium channel blocker, CyA = cyclosporine, eGFR = estimated Glomerular Filtration Rate, HDL = high-density lipoprotein, LDL = low-density lipoprotein, MMP = mycophenolate mofetil. **Conclusion**: Recipient CAD history and donor age >45 years were significantly associated with CAV development at 3 years after HTx. These results are consistent with prior studies and underscore the importance of donor-recipient risk profiling to improve prediction of post-HTx outcomes and may warrant more intensive prevention measures.

Literature

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3. Nagji AS, Hranjec T, Swenson BR, Kern JA, Bergin JD, Jones DR, et al. Donor age is associated with chronic allograft vasculopathy after adult heart transplantation: implications for donor allocation. Ann Thorac Surg. 2010 July;90(1):168–75. https://doi.org/10.1016/j.athoracsur.2010.03.043