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CLINICAL STUDIES

Low incidence of transplant coronary artery disease in chinese heart recipients

Ron-Bin Hsu, MD^*, Shu-Hsun Chu, MD^*, Shoei-Shen Wang, MD^*, Wen-Je Ko, MD^*, Nai-Kuan Chou, MD^*, Chii-Ming Lee, MD, Ming-Fong Chen, MD and Yuan-Teh Lee, MD

^* Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Manuscript received July 31, 1998; revised manuscript received January 8, 1999, accepted January 21, 1999.

Reprint requests and correspondence: Dr. Shu-Hsun Chu, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd. Taipei, Taiwan 100, R.O.C
shchu{at}ha.mc.ntu.edu.tw

OBJECTIVES

This study sought to assess the incidence of transplant coronary artery disease (CAD) in Chinese heart recipients.

BACKGROUND

The prevalence of transplant CAD detected by angiography at 1, 2 and 4 years after heart transplantation was 11%, 22% and 45%, respectively. The incidence of transplant CAD in Chinese heart recipients has not been reported.

METHODS

For those recipients surviving for more than 1 year after transplantation, coronary angiography was performed annually for surveillance of transplant CAD. The recipient characteristics, donor characteristics, rejection episodes, medication and human leukocyte antigen (HLA) mismatches were recorded.

RESULTS

Fifty patients were included in this study. Thirteen (26%) recipients had ischemic heart disease. Two patients (4%) had active cytomegalovirus (CMV) infection after transplantation. The mean number of rejection episodes in the 1st year after transplantation was 1.15. Among 47 patients with complete data of donor and recipient histocompatibility antigens, there were seven patients (14.9%) with two or fewer HLA mismatches. Among 74 angiograms of 50 patients reviewed, only one patient had discrete stenosis less than 50% in the middle portion of the left anterior descending artery at 1 year after transplantation. The cumulative incidence of transplant CAD was 2% at 1 year and 2% at 2 and 4 years after transplantation.

CONCLUSIONS

The incidence of transplant CAD was low in Chinese heart transplant recipients. Low percentage of ischemic heart disease in recipients, low occurrence of active CMV infection and rejection episodes after transplantation, less racial disparity, and lower HLA mismatches may be the important factors.

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