Long-term outcome of cardiac allograft vasculopathy: Importance of the International Society for Heart and Lung Transplantation angiographic grading scale

Abstract Background Cardiac allograft vasculopathy (CAV) is a major complication limiting long-term survival after heart transplantation (HTx). However, long-term outcome data of HTx recipients with detailed information on angiographic severity are scarce. Methods The study included 501 HTx recipients with angiographic follow-up up to 20 years post-transplant. All coronary angiograms were classified according to the International Society for Heart and Lung Transplantation (ISHLT) grading scale. Results CAV prevalence increased over time after transplantation, reaching 10% at 1 year, 44% at 10 years and 59% at 20 years. Older donor age (hazard ratio (HR) 1.38 per 10 years, 1.20–1.59, p Conclusions CAV is highly prevalent in HTx recipients, and is explained by immunological and non-immunological factors. Higher ISHLT CAV grades are independently associated with worse graft survival.