Influence of donor-transmitted coronary artery disease on long-term outcomes after heart transplantation-a retrospective study.

Background Cardiac allograft vasculopathy (CAV) is an important cause of late mortality after heart transplantation, which may be influenced by pre-existing coronary disease (CAD) in the donor heart. Methods The aim of this study was to verify whether CAD in the donor heart had any influence on survival, cardiac-related adverse events (CRAEs) and coronary disease progression after transplantation. Donor coronary angiography performed in 289 hearts showed absence of CAD in 232 (no-CAD group) and moderate (≤50%) stenoses (CAD group) in 57. The 2 groups were compared for survival, freedom from CRAEs and development of grade ≥2 CAV after transplantation. Results 30-day mortality and postoperative complications-rate was similar as mean follow-up (76±56 and 75±55 months) for no-CAD and CAD (p=0.8). Ten-year actuarial survival was 58±4% and 62±7% for no-CAD and CAD (p=0.4). Ten-year freedom from grade ≥2 CAV and from CRAEs was 81±4% and 66±5% vs 75±8% and 67±9% in no-CAD and CAD (p=0.9 and 0.9 respectively). Conclusions Donor hearts with moderate CAD did not affect survival, freedom from CRAEs and did not accelerate development of high-grade CAV after transplantation supporting the use of such grafts to expand the donor pool. Routine use of coronary angiography in donor selection appears justified.