초록접수 현황
| 14F-219 | 구연 발표 |
Risk Factors for the Development of Cardiac Allograft Vasculopathy after Heart Transplantation
Ju Yong Lim, Jeong-Jun Park, Tae-Jin Yun, Jae Won Lee, Sung Ho Jung
Department of Thoracic and cardiovascular surgery, Asan Medical Center, university of Ulsan college of medicine
Background : Although outcomes of heart transplantation have improved, cardiac allograft vasculopathy (CAV) still remains a significant cause of mortality. We sought to identify the risk factors for the development of CAV after heart transplantation.
Methods : Between 1992 and July, 2014, 399 patients underwent heart or heart lung transplantation. Coronary angiography (CAG) of these patients were reviewed and classified as grade 0 to 3 by International Society of Heart Lung Transplantation (ISHLT) classification. Abnormal findings of CAG within one month after heart transplantation were considered as transmitted coronary disease and excluded from the risk factor analysis. Cox proportional hazard model was used for the identification of risk factors.
Results : 54 (13.5%) patients were diagnosed with CAV; Grade 1 (n=45), Grade 2 (n=8), Grade 3 (n=1) during the median follow up 45 months (1-256 months). Freedom from CAV was 99%, 82.4%, 60.3% at 1, 5, and 10 years, respectively. Mortality rate was 20.4% (n=11), which was similar to non-CAV patients (p=0.12). 9 patients underwent percutaneous coronary intervention. During mean 4.8±2.1 years of CAG follow up, 2 patients showed negative remodeling from Grade 1 to 0, and Grade 1 CAV deteriorated to Grade 2 or 3 in 3 patients. Univariate analysis showed donor age older than 25 years, preoperative diabetes, inotropic support, ischemic time longer than 120 minutes, Cytomegalo virus infection, use of Tacrolimus as risk factors. Multivariate analysis identified use of Tacrolimus (Hazard Ratio (HR) 2.4, p=0.01) and Donor age older than 25 years (HR 2.1, p=0.038) as significant risk factors for CAV.
Conclusion : Incidence of the development of CAV was 13.5%, which was acceptable. Postoperative use of Tacrolimus and donor age older than 25 years were the only significant risk factors of CAV.
Methods : Between 1992 and July, 2014, 399 patients underwent heart or heart lung transplantation. Coronary angiography (CAG) of these patients were reviewed and classified as grade 0 to 3 by International Society of Heart Lung Transplantation (ISHLT) classification. Abnormal findings of CAG within one month after heart transplantation were considered as transmitted coronary disease and excluded from the risk factor analysis. Cox proportional hazard model was used for the identification of risk factors.
Results : 54 (13.5%) patients were diagnosed with CAV; Grade 1 (n=45), Grade 2 (n=8), Grade 3 (n=1) during the median follow up 45 months (1-256 months). Freedom from CAV was 99%, 82.4%, 60.3% at 1, 5, and 10 years, respectively. Mortality rate was 20.4% (n=11), which was similar to non-CAV patients (p=0.12). 9 patients underwent percutaneous coronary intervention. During mean 4.8±2.1 years of CAG follow up, 2 patients showed negative remodeling from Grade 1 to 0, and Grade 1 CAV deteriorated to Grade 2 or 3 in 3 patients. Univariate analysis showed donor age older than 25 years, preoperative diabetes, inotropic support, ischemic time longer than 120 minutes, Cytomegalo virus infection, use of Tacrolimus as risk factors. Multivariate analysis identified use of Tacrolimus (Hazard Ratio (HR) 2.4, p=0.01) and Donor age older than 25 years (HR 2.1, p=0.038) as significant risk factors for CAV.
Conclusion : Incidence of the development of CAV was 13.5%, which was acceptable. Postoperative use of Tacrolimus and donor age older than 25 years were the only significant risk factors of CAV.
책임저자: Sung Ho Jung
Department of Thoracic and cardiovascular surgery, Asan Medical Center, university of Ulsan college of medicine
연락처 : 임주영, Tel: 02-3010-1777 , E-mail : milla92@yahoo.com
