Lipid disorder and transplant coronary artery disease in long-term survivors of heart transplantation.

BACKGROUND: Transplant coronary artery disease is the major cause of late mortality after heart transplantation. The underlying mechanism probably involves various factors including immunologic and nonimmunologic factors. METHODS: The influence of various risk factors concerning both the development and the progression of transplant coronary artery disease was analyzed. Fifty-two heart transplant patients, who survived at least 2 years after transplantation (24 to 60 months), were included. RESULTS: Of these patients 38.5% had angiographic evidence of transplant coronary artery disease. They had significantly higher values of total cholesterol, low-density lipoprotein cholesterol, and log triglycerides than patients without evidence of the disease (p = 0.037, p = 0.002, and p = 0.015, respectively). In addition, preoperative diagnosis of coronary artery disease was a predictor of the development of transplant coronary artery disease, whereas significant differences were not found corresponding to recipient age, donor age, ischemic time, body mass index, lipoprotein (a) value, high-density lipoprotein cholesterol value, time after transplantation, number of postoperative rejection episodes, or prednisone dosage. A 12-month angiographic follow-up indicated disease progression in 25% of the patients. With respect to the majority of factors analyzed within the study, the differences between patients with and those without progression were comparable to the differences between patients in whom transplant coronary artery disease developed and those in whom it did not. However, patients exhibiting disease progression had a higher prednisone intake dosage (p = 0.006) and had significantly higher lipoprotein (a) values (p = 0.0229) than patients without progression. CONCLUSION: This study clearly shows that in heart transplant patients surviving more than 2 years, lipid disorder is one of the main risk factors of both the development and the progression of transplant coronary artery disease.