RELATIONSHIP OF IMMUNOSUPPRESSION AND SERUM-LIPIDS TO THE DEVELOPMENT OF CORONARY ARTERIAL-DISEASE IN THE TRANSPLANTED HEART

Coronary arterial disease in the cardiac allograft has emerged as the most serious long term complication of cardiac transplantation. The influence of patient-related and other potential risk factors on the development of coronary arterial disease at 1 year subsequent to cardiac transplantation was examined in 207 recipients. The mean age of donors in patients with coronary arterial disease was 28.5 +/- 9.5 years, compared to 22.6 +/- 7.9 years in patients without coronary arterial disease (P < 0.01). Eight of the 35 patients who received immunosuppression by means of prednisone and azathioprine developed coronary arterial disease compared to 5 of the 172 patients who were treated with cyclosporin and azathioprine without routine oral prednisone (P < 0.01). The relationship of levels of serum lipids to the subsequent development of coronary arterial disease was investigated in 95 patients with angiographically normal coronary arteries one year after cardiac transplantation. The cumulative probability of coronary arterial disease in those with total cholesterol > 5.8 mmol/l was 9.3% at 2 years (n = 40), 24.4% at 4 years (n = 21) and 45% at 4 years (n = 9) compared with 4.3% at 2 years (n = 45), 7.4% at 3 years (n = 32) and 14% at 4 years (n = 14) in those with a total cholesterol < 5.8 mmol/l (P < 0.05). Similarly, the incidence of coronary arterial disease was increased in patients with serum triglyceride > 1.4 mmol/l (P < 0.05). We conclude that the incidence of coronary arterial disease after cardiac transplantation is affected by the age of the donor, type of immunosuppression and serum concentrations of lipids. Modification of these factors may reduce the incidence of coronary arterial disease in transplanted hearts.