Faculty Collaboration Database

Combined heart and liver transplant attenuates cardiac allograft vasculopathy compared with isolated heart transplantation. Transplantation 2013 Mar 27;95(6):859-65

Date

02/01/2013

Pubmed ID

23364484

Pubmed Central ID

PMC3733541

DOI

10.1097/TP.0b013e31827eef7e

Scopus ID

2-s2.0-84877593849 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

BACKGROUND: We evaluated whether combined heart and liver transplant (H+LTx) can protect the heart graft from the development of cardiac allograft vasculopathy using coronary three-dimensional (3D) volumetric intravascular ultrasound (IVUS).

METHODS: From 2004 to 2009, we identified 24 isolated heart transplant (HTx) and 10 H+LTx recipients in whom two coronary 3D IVUS studies were performed 1 year apart. Baseline 3D IVUS was performed at 0.22 (0.17-1.16) years after transplantation, with follow-up 3D IVUS exams performed after baseline exam (0.96 [0.83-1.08]).

RESULTS: Rate of plaque volume and plaque index (plaque volume/vessel volume) progression was attenuated in the H+LTx group (0.3±1.1 vs. 1.5±2.9 mm/mm; P=0.08 and 0.01±0.03 vs. 0.1±0.1; P=0.004, respectively). Rejection burden was much lower in the H+LTx patients. Outcome analysis in 66 consecutive patients (56 HTx and 10 H+LTx) was performed irrespective of performance of second coronary IVUS. H+LTx was associated with reduced rate of cardiac events (P=0.04), which remained significant when adjusted for the difference in the primary etiology for heart disease (P=0.05).

CONCLUSIONS: Our preliminary serial 3D coronary IVUS data show that H+LTx attenuates cardiac allograft vasculopathy by decreasing the rate of plaque volume and plaque index progression and improves coronary-related outcomes. Because of the small numbers and the differences in etiology of heart disease, our data should be interpreted cautiously, and larger clinical trials would be required to recommend H+LTx for improved coronary remodeling.

Author List

Topilsky Y, Raichlin E, Hasin T, Boilson BA, Schirger JA, Pereira NL, Edwards BS, Clavell AL, Rodeheffer RJ, Frantz RP, Gandhi MJ, Maltais S, Park SJ, Daly RC, Lerman A, Kushwaha SS

Author

Eugenia Raichlin MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Coronary Vessels
Female
Follow-Up Studies
Heart Transplantation
Humans
Imaging, Three-Dimensional
Liver Transplantation
Male
Middle Aged
Plaque, Atherosclerotic
Proportional Hazards Models
Transplantation, Homologous
Treatment Outcome
Ultrasonography, Interventional
Vascular Diseases