Risk factors for mid-term progression of cardiac allograft vasculopathy after heart transplantation only include donor characteristics in a large single center cohort

Background Multiple risk factors of cardiac allograft vasculopathy (CAV) have been described, particularly through the analysis of large northern American cohorts. However, discrepancies in donor selection between the US and European countries are important, particularly concerning donor age. Purpose To evaluate the risk factors for the early development and progression of CAV in a European heart transplantation high volume center. Methods We performed an observational, retrospective single center study. All patients with heart transplantation between 10/01/2008 and 12/31/2013 who had at least one coronary angiography were included. We searched for risk factors of #1 the occurrence of moderate to severe CAV (CAV grades 2 to 3) and #2 the evolution of CAV during follow-up (CAV grade+1 or more compared to baseline) by analyzing the effect of #1 donor risk factors (age, sex, cardiovascular risk factors…), #2 recipient cardiovascular risk factors and #3 recipient transplant-related risk factors (CMV infection, ischemic time, pre-formed donor specific antibodies, biopsy proven rejections…). Results During the study period, 398 patients were transplanted at our center. Among them, 287 had at least one coronary angiogram (analysis of risk factors for CAV 2–3 occurrences) including 206 patients with at least two coronary angiograms (analysis of the evolution of CAV during follow-up). The median follow-up was 5.2 years. After multivariate analyses, only donor risk factors were significantly associated with 1) the risk of occurrence of CAV 2 to 3 (donor age > 40 years: sHR = 6.3, CI = 2–20; smoking: sHR = 2.1, CI = 1.1–4.1; donor sex: female sex: sHR = 0.31, CI = 0.13–0.73) and the risk of CAV progression during follow-up (donor age > 40 years: sHR = 2.9, CI = 1.2–7.2; donor sex: female sex: sHR = 0.2, CI = 0.1–0.6). Conclusion Early moderate to severe CAV occurrence and early CAV progression after heart transplantation were mostly driven by donor characteristics.