Life expectancy of heart recipients with donor-transmitted coronary atherosclerosis

Introduction. Heart transplantation (HT) is an extreme treatment for chronic congestive heart failure. One of the ways of reducing deficit of donor organs was to expand the criteria for selection of donors in favor of heart retrieval from older donors. This became one of the causes increasing the risk of donor-transmitted coronary atherosclerosis (DTCA). The impact of endovascular DTCA correction on postoperative survival of heart recipients remains poorly studied. Objective: to estimate the life expectancy of heart recipients with donor-transmitted coronary atherosclerosis. Materials and methods. The life expectancy of 518 heart recipients who underwent coronarography during the first week after HT was evaluated. When hemodynamically significant stenosis of the coronary arteries was detected, percutaneous coronary intervention (PCI) was performed as planned. The average age of recipients was 46.92 ± 1 year (10 to 72 years). 90% of them were men. Recipients’ initial UNOS status was distributed as follows: UNOS 1a – 217 people, UNOS 1b – 89 and UNOS 2 – 212. Two groups were formed based on coronary angiography results. Group 1 included patients with DTCA signs, Group 2 was the control group (without DTCA). The first group was divided into 2 subgroups – a subgroup with DTCA signs, but without hemodynamically significant lesions (without PCI), and a subgroup with DTCA, where PCI was performed (PCI). Results. The age of recipients in both groups (DTCA and without DTCA) did not differ – 47.54 ± 1.01 and 46.64 ± 0.64 years, respectively. Donors were older in the DTCA group (50.2 ± 0.7 years) than in the control group (41 ± 0.5 years) (p = 0.0005). Survival in the control group averaged 58.25 ± 1.17 months, and in the DTCA group – 53.16 ± 0.36 months (p = 0.033). The difference in life expectancy of patients who underwent PCI (51.18 ± 2.9 months) and patients of the control group (58.25 ± 1.17 months) was not statistically significant (p = 0.88). In the group where graft showed signs of atherosclerotic changes in the coronary arteries, the cause of donor brain death from cerebrovascular accident was more common than in the control group. Conclusion. The risk of DTCA is associated with the donor’s age and the death of the donor brain from vascular causes. Endovascular correction of atherosclerotic lesions of coronary arteries makes it possible to neutralize the impact of transplant coronary artery stenosis on long-term outcome of HT surgery.

heart transplantation, donor‑transmitted coronary atherosclerosis, percutaneous coronary intervention

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