Cardiac allograft vasculopathy outcomes among donation after circulatory death heart transplant recipients
Antoinette S. Birs, MD,
Quan M. Bui, MD,
Yan Gernhofer,
Antonio Duran, MD,
Lucas Keyt, MD,
Kevin Paternostro, MD,
Jeffrey Ding,
Eric Adler, MD,
Lawrence Ang, MD,
Marcus A. Urey, MD,
Mark J. Kearns, MD,
Nicholas Wettersten, MD,
Victor Pretorius, MBchB
Affiliations
Antoinette S. Birs, MD
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California; Corresponding author. Antoinette S. Birs, MD, Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9394 Medical Center Drive, La Jolla, CA, USA.
Quan M. Bui, MD
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
Yan Gernhofer
University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas
Antonio Duran, MD
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
Lucas Keyt, MD
University of California San Diego School of Medicine, La Jolla, California
Kevin Paternostro, MD
University of California San Diego School of Medicine, La Jolla, California
Jeffrey Ding
University of California San Diego School of Medicine, La Jolla, California
Eric Adler, MD
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
Lawrence Ang, MD
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
Marcus A. Urey, MD
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
Mark J. Kearns, MD
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California
Nicholas Wettersten, MD
Division of Cardiovascular Medicine, San Diego Veterans Affairs Medical Center, San Diego, California
Victor Pretorius, MBchB
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California
Background: Cardiac allograft vasculopathy (CAV) accounts for significant long-term morbidity and mortality in heart transplant recipients; limited data exist for donation after circulatory death (DCD). Intravascular ultrasound (IVUS) assessment is a gold standard for early diagnosis of CAV and has strong prognostic power. Methods: We evaluated all consecutive circulatory and brain death heart transplant recipients from January 2020 to March 2022. Patients were followed for need for percutaneous coronary intervention (PCI), development of severe allograft vasculopathy, or death. Among 143 heart transplant recipients, 39 received circulatory death and 104 received brain death hearts. Results: Baseline characteristics were similar between groups: median age (56.3 vs 53.7 years, p = 0.290), female sex (15% vs 26%, p = 0.265), and sirolimus use (69% vs 53%, p = 0.116). At 1 year, there were no significant differences in maximal intimal thickness (0.49 vs 0.46 mm, p = 0.861) or Stanford classification. During a median follow-up of 793 days [interquartile ranges 618, 1003], there was no difference in the unadjusted or adjusted primary composite outcome of death, PCI, or International Society of Heart and Lung Transplantation cardiac allograft vasculopathy maximal intimal thickness ≥0.6 mm (unadjusted hazard ratio (HR) 0.42, 95% confidence interval (CI): 0.05, 3.48, p = 0.42), event rate 9.6% vs 2.6%, p = 0.29, nor was there a difference in death, PCI or severe IVUS disease (HR 1.44, 95% CI 0.81, 2.56, p = 0.21). Conclusion: In DCD heart transplant recipients, circulatory death donors did not have a significantly higher risk for coronary allograft vasculopathy by IVUS or related complications at 1 year following transplantation.
