Combined heart and liver transplant attenuates cardiac allograft vasculopathy compared with isolated heart transplantation

Yan Topilsky, Eugenia Raichlin, Tal Hasin, Barry A. Boilson, John A. Schirger, Naveen L. Pereira, Brooks S. Edwards, Alfredo L. Clavell, Richard J. Rodeheffer, Robert P. Frantz, Manish J. Gandhi, Simon Maltais, Soon J. Park, Richard C. Daly, Amir Lerman, Sudhir S. Kushwaha

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19 Scopus citations

Abstract

Background. We evaluated whether combined heart and liver transplant (H+LTx) can protect the heart graft from the development of cardiac allograft vasculopathy using coronary three-dimensional (3D) volumetric intravascular ultrasound (IVUS). Methods. From 2004 to 2009, we identified 24 isolated heart transplant (HTx) and 10 H+LTx recipients in whom two coronary 3D IVUS studies were performed 1 year apart. Baseline 3D IVUS was performed at 0.22 (0.17-1.16) years after transplantation, with follow-up 3D IVUS exams performed after baseline exam (0.96 [0.83-1.08]). Results. Rate of plaque volume and plaque index (plaque volume/vessel volume) progression was attenuated in the H+LTx group (0.3±1.1 vs. 1.5±2.9 mm3/mm; P=0.08 and 0.01±0.03 vs. 0.1±0.1; P=0.004, respectively). Rejection burden was much lower in the H+LTx patients. Outcome analysis in 66 consecutive patients (56 HTx and 10 H+LTx) was performed irrespective of performance of second coronary IVUS. H+LTx was associated with reduced rate of cardiac events (P=0.04), which remained significant when adjusted for the difference in the primary etiology for heart disease (P=0.05). Conclusions. Our preliminary serial 3D coronary IVUS data show that H+LTx attenuates cardiac allograft vasculopathy by decreasing the rate of plaque volume and plaque index progression and improves coronary-related outcomes. Because of the small numbers and the differences in etiology of heart disease, our data should be interpreted cautiously, and larger clinical trials would be required to recommend H+LTx for improved coronary remodeling.

Original languageEnglish (US)
Pages (from-to)859-865
Number of pages7
JournalTransplantation
Volume95
Issue number6
DOIs
Publication statusPublished - May 27 2013

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Keywords

  • 3D intravascular ultrasound
  • Cardiac allograft vasculopathy
  • Heart transplant
  • Liver transplant

ASJC Scopus subject areas

  • Transplantation

Cite this

Topilsky, Y., Raichlin, E., Hasin, T., Boilson, B. A., Schirger, J. A., Pereira, N. L., ... Kushwaha, S. S. (2013). Combined heart and liver transplant attenuates cardiac allograft vasculopathy compared with isolated heart transplantation. Transplantation, 95(6), 859-865. https://doi.org/10.1097/TP.0b013e31827eef7e