Allograft morphology and function in heart transplant recipients surviving more than 15 years by magnetic resonance imaging and dual-source computed tomography
Mastrobuoni S, Dell'aquila AM, Arraiza M, Bastarrika G, Azcarate PM, Pueyo J, Rabago G, Herreros J.
Department of Cardiovascular Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Spain
Cardiac allograft vasculopathy and late graft failure are the main limiting factors of long-term success of heart transplantation, and little is known about graft function in the long-term survivors.
The aim of this study was to assess the ventricular function and the allograft vasculopathy in long-term survivors (>15 years) with the cardiac magnetic resonance imaging (MRI) and dual-source computed tomography (DSCT) coronary angiogram.
In our database, 34 cardiac recipients have more than 15 years of follow-up and were evaluated for this study; 22 (65%) of them were enrolled. Mean age at transplant was 46±13.5 years, mean donor age was 28.5±10.1 years, and mean graft ischemic time was 189±58min. Mean follow-up was 18.5±2.4 years (range 15-22). All patients underwent cardiac MRI and DSCT.
Mean left ventricular (LV) volumes indexed to the body surface area (BSA) were within normal range: the end-diastolic volume/BSA was 61±16mlm(-2), end-systolic volume/BSA was 22±15mlm(-2), stroke volume/BSA was 38±6mlm(-2), LV mass/BSA: 72±18gm(-2), and mean ejection fraction (EF) was 0.59±0.08. Two patients (9%) showed a global cardiac hypokinesia and two other patients (9%) showed akinesia of one segment. At DSCT, 41% of patients had a strictly normal coronary angiogram, 41% had wall thickening and 18% presented a least one >60% stenosis.
Cardiac MRI and DSCT coronary angiogram revealed a normal graft function and morphology after more than 15 years of transplantation. However, a certain number of patients have significant cardiac allograft vasculopathy and another consistent group has initial disease. These patients deserve further follow-up and tailoring of the immunosuppressive regimen.
CITATION Eur J Cardiothorac Surg. 2011 Mar 28