Cardiac allograft vasculopathy epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
As per the data from the Registry of the International Society of Heart and Lung transplantation[1], the number of reported heart transplants has increased slowly in the recent years, especially in North America. The overall prevalence of CAV in post-cardiac transplant patients at 1, 5 and 10 years is 8, 30 and 50% respectively.
Epidemiology and Demographics
As per the ISHLT, the prevalence of CAV in post- cardiac transplant patients at 1, 5 and 10 years is 8, 30 and 50% respectively. The actual incidence of CAV has decreased slightly over time. Moreover, CAV as a cause of death in patients post- transplantation has decreased over the last decade. However, the Kaplan-Meier curves demonstrates a steady increase in the incidence of CAV post-transplant, such that only 46% of patients are free from angiographic evidence of CAV at the end of 10 years. Moreover, the survival after development of CAV appears to have minimal improvement in recent years in comparison to immediately preceding years. Donor age, donor history of hypertension, hyperlipidemia, number of HLA mismatches and recipient diagnosis of ischemic heart disease were important predictors for development of CAV. Similar results were derived from the review of the United Network of Organ Sharing (UNOS) heart transplant database was performed by Nagji and colleagues in 2010 [2].
The Cardiac Transplant Research Database revealed a higher incidence of CAV in post-transplant patients of 42% at the end of 5 years, whereas only 7% of patients were found to have severe CAV on coronary angiogram over the same period of time. The presence of severe CAV was highly predictive of subsequent events or re-transplantation. Similar to the ISHLT and UNOS, older donor age, male donor or recipient, donor hypertension, diabetes were predictive of development of CAV [3].
Another prospective cross sectional study done by Torres and colleagues showed almost doubled prevalence of CAV when measured by intravascular ultrasound (IVUS) in contrast to conventional coronary angiography, which suggests that the incidence of CAV may in reality be more than predicted.
Age
Gao et al. demonstrated that older donor age has a strong co-relation with development of CAV within 3 years following transplant. However, no significant difference was noted in long term mortality in patients receiving heart transplants from older age group donors. Similar results were obtained from the ISHTL registry and UNOS database.
Gender
The UNOS database found significant improvement in short and long term mortality in males who received transplants from same sex donors. However, no survivial advantage was found in females receiving transplants from female donors. A study done by Al-Khaldi et al. showed worse graft outcomes especially in men above 45 years of age who received female allografts.
References
- ↑ Taylor DO, Edwards LB, Boucek MM, Trulock EP, Aurora P, Christie J; et al. (2007). "Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult heart transplant report--2007". J Heart Lung Transplant. 26 (8): 769–81. doi:10.1016/j.healun.2007.06.004. PMID 17692781.
- ↑ Nagji AS, Hranjec T, Swenson BR, Kern JA, Bergin JD, Jones DR; et al. (2010). "Donor age is associated with chronic allograft vasculopathy after adult heart transplantation: implications for donor allocation". Ann Thorac Surg. 90 (1): 168–75. doi:10.1016/j.athoracsur.2010.03.043. PMC 3033784. PMID 20609769.
- ↑ Costanzo MR, Naftel DC, Pritzker MR, Heilman JK, Boehmer JP, Brozena SC; et al. (1998). "Heart transplant coronary artery disease detected by coronary angiography: a multiinstitutional study of preoperative donor and recipient risk factors. Cardiac Transplant Research Database". J Heart Lung Transplant. 17 (8): 744–53. PMID 9730422.