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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Cardiac Allograft Vasculopathy in Redo-Transplants: Is It More or Less (or) the Same the Second Time around?

      Purpose

      Cardiac Allograft Vasculopathy (CAV) continues to hinder the long term success of heart transplant recipients. Redo-transplantation is currently the only definitive treatment for advanced CAV. Whether these patients are at similar CAV-risk with the second transplant remains unknown and the topic of interest in this study.

      Methods

      The UTAH Cardiac Transplant database was queried for all patients who were retransplanted from 1985 to 2011. Heart recipients who did not have CAV as an indication for redo-transplantation were excluded. CAV diagnosis was made by coronary angiography and based on the 2010 ISHLT standardized nomenclature for CAV. Patient demographics, rejection history, and CAV incidence were analyzed.

      Results

      Of the 1,169 eligible patients, 135 (11.5%) developed CAV post their first transplant; 78 cases within 10 years and 54 beyond 10 years. The mean time to CAV was 6.58 years. Of the 135 patients who developed CAV, only 21 (15.5%) ended up requiring a redo-transplant. Of the 21 patients retransplanted, 4 (19.0%) developed CAV again; 2 patients within 10 years and 2 patients beyond 10 years. The incidence of CAV was statistically similar (p=NS) between 1st and redo-transplant. Baseline characteristics (see table) are included.

      Conclusion

      Our results indicate that CAV is as likely to develop in redo-transplants despite recent advances in immunosuppression and the standardized use of lipid-lowering agents. Although outcomes in redo-transplantation for the indication of CAV are favorable, efforts to better understand and minimize CAV are needed, especially in the face of scarce donor organs.
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