Heart transplant coronary artery disease in Chinese recipients.
BACKGROUND
Transplant coronary artery disease is the principle limiting factor for long-term survival of heart transplantation (HTx) recipients. We reviewed our data to assess the incidence of this disorder among Chinese HTx recipients and to compare it with the results of Western studies.


METHODS
From July 1988 to May 2002, 182 patients received 184 orthotopic HTx. One hundred sixty-three recipients survived for at least 1 year with available SPECT scans or coronary angiogram studies. The data set included donor characteristics, recipient characteristics, active cytomegalovirus (CMV) infection rate, rejection episodes, immunosuppressants, and human leukocyte antigen (HLA) mismatches.


RESULTS
Surgical mortality in our program was 4.3% and the actuarial freedom from coronary artery disease at 1, 3, and 5 years was 99%, 95%, and 92%, respectively. Angiogram results were stratified into coronary artery disease (n = 15) or absence of the disorder (n = 148) groups. Only older donor age showed statistical significance between the groups. Compared with the Western series, the present data show higher actuarial survival rates and freedom from coronary artery disease. There were statistically significant differences in regard to graft ischemia time, proportion of male recipients, ischemic heart disease, rejection episodes during the first year, and incidence of CMV infection.


CONCLUSIONS
SPECT scan can detect coronary artery disease before there is significant stenosis of the coronary artery with acceptable survival rates. Chinese HTx recipients show a lower incidence of the disorder, lower rates of ischemia heart disease, lower proportion of male gender, lower incidence of CMV infection, fewer rejection episodes during the first year, and less ischemic time than Western recipients, which maybe the contributing factors to their better survival.
Lee
K C
KC
Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan. ch9066@chgh.org.tw
Chang
C Y
CY
Chuang
Y C
YC
Young
M S
MS
Huang
C M
CM
Yin
W H
WH
Tung
D Y
DY
Lee
W C
WC
Lee
S L
SL
Sue
S H
SH
Wei
J
J
D000328:Adult; D002681:China / Q000208:ethnology; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome