OCCULT AND FREQUENT TRANSMISSION OF ATHEROSCLEROTIC CORONARY-DISEASE WITH CARDIAC TRANSPLANTATION - INSIGHTS FROM INTRAVASCULAR ULTRASOUND

Background Transplant coronary artery disease is a major cause of morbidity and mortality after cardiac transplantation. However, limited data exist regarding the potential contribution of coronary atherosclerosis in the donor heart to cardiac-allograft vasculopathy. Methods and Results We performed quantitative coronary angiography and intravascular ultrasound imaging in 50 of 62 consecutive heart-transplant recipients (40 men, 10 women, mean age, 53+/-9 years) 4.6+/-2.6 weeks after transplantation. The donor population consisted of 30 men and 20 women (mean age, 32+/-12 years). Ultrasound imaging visualized all three coronary arteries in 22 patients, two coronary arteries in 23, and one coronary artery in 5. Ultrasound imaging detected coronary atherosclerosis (intimal thickness greater than or equal to 0.5 mm) in 28 patients (56%). However, the angiography was abnormal in only 13 patients (26%). The sensitivity and specificity of coronary angiography were 43% and 95%, respectively. With ultrasound, the average atherosclerotic plaque was 1.3+/-0.6 mm and the cross-sectional area narrowing was 34+/-16%. Atherosclerotic involvement frequently was focal (85%), eccentric (mean eccentricity index, 87+/-8), and near arterial bifurcations. Donors of the transplant recipients with coronary atherosclerosis were older than those without atherosclerosis (37+/-12 versus 25+/-10 years, P=.001). Maximal intimal thickness correlated with donor age (r=.54, P=.0001). Multivariate analysis demonstrated that donor age (P=.0001), male sex of donor (P=.0006), and recipient age (P=.03) were independent predictors of atherosclerosis. Conclusions Coronary atherosclerosis is frequently but inadvertently transmitted by means of cardiac transplantation from the donor to the recipient. Long-term outcomes of donor-transmitted coronary artery disease will require further evaluation.