Comparison of cardiac allograft vasculopathy incidence between simultaneous multiorgan and isolated heart transplant recipients in the United States.

Autor:	Shahandeh N; Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California., Kim JS; Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California., Klomhaus AM; Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, California., Tehrani DM; Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California., Hsu JJ; Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California., Nsair A; Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California., Khush KK; Division of Cardiovascular Medicine, Stanford University, Stanford, California., Fearon WF; Division of Cardiovascular Medicine, Stanford University, Stanford, California; Division of Cardiology, VA Palo Alto Health Care Systems, Palo Alto, California., Parikh RV; Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California. Electronic address: rparikh@mednet.ucla.edu.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2024 Oct; Vol. 43 (10), pp. 1737-1746. Date of Electronic Publication: 2024 Jun 29.
DOI:	10.1016/j.healun.2024.06.014
Abstrakt:	Background: Prior studies have shown reduced development of cardiac allograft vasculopathy (CAV) in multiorgan transplant recipients. The aim of this study was to compare the incidence of CAV between isolated heart transplants and simultaneous multiorgan heart transplants in the contemporary era. Methods: We utilized the Scientific Registry of Transplant Recipients to perform a retrospective analysis of first-time adult heart transplant recipients between January 1, 2010 and December 31, 2019 in the United States. The primary end-point was the development of angiographic CAV within 5 years of follow-up. Results: Among 20,591 patients included in the analysis, 1,279 (6%) underwent multiorgan heart transplantation (70% heart-kidney, 16% heart-liver, 13% heart-lung, and 1% triple-organ), and 19,312 (94%) were isolated heart transplant recipients. The average age was 53 years, and 74% were male. There were no significant between-group differences in cold ischemic time. The incidence of acute rejection during the first year after transplant was significantly lower in the multiorgan group (18% vs 33%, p < 0.01). The 5-year incidence of CAV was 33% in the isolated heart group and 27% in the multiorgan group (p < 0.0001); differences in CAV incidence were seen as early as 1 year after transplant and persisted over time. In multivariable analysis, multiorgan heart transplant recipients had a significantly lower likelihood of CAV at 5 years (hazard ratio = 0.76, 95% confidence interval: 0.66-0.88, p < 0.01). Conclusions: Simultaneous multiorgan heart transplantation is associated with a significantly lower long-term risk of angiographic CAV compared with isolated heart transplantation in the contemporary era. (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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