Introduction: Cardiac allograft vasculopathy (CAV) remains one of the major factors limiting long-term survival. According to the ISHLT registry, CAV incidence is approximately 30% at 5 years and 50% at 10 years. CAV development is attributed to immunological mechanisms such as the formation of donor-specific antibodies, T-cell activation, and altered cytokine expression. However, there are immunologically-privileged patients that do not have detectable CAV by yearly angiography in the first 5 years These patients most likely will not have the development of subsequent CAV in the ensuing 5 years due to their immunologically-privileged status. We sought to assess whether these patients required annual angiograms to be performed after the first five 5 years.
Methods: Between 1994 and 2003 we assessed 239 heart transplant (HTx) patients who have had normal angiograms (ISHLT CAV 0) for the first five years after HTx. Angiographic CAV was characterized by the ISHLT nomenclature definitions for CAV1 (mild), CAV2 (moderate), CAV3 (severe). Freedom from CAV ≥ ISHLT CAV2 (significant CAV) from years 6 to 10 was evaluated.
Results: As per protocol, freedom from any CAV was 100% at 5 years. From years 6-10, freedom from CAV ≥ ISHLT CAV2 was 97.0% and survival was 85.8%. (see table)
Conclusion: Patients who have normal angiograms at 1-5 years after HTx appear to be immunologically privileged and do not develop significant CAV in years 6-10. Therefore, these patients should have markedly reduced angiograms performed, which will result in significant financial savings.