Combined heart and liver transplant attenuates cardiac allograft vasculopathy compared with isolated heart transplantation.
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 mm/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.
Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel Aviv, Israel.
Yan
Y
Topilsky
Eugenia
E
Raichlin
Tal
T
Hasin
Barry A
BA
Boilson
John A
JA
Schirger
Naveen L
NL
Pereira
Brooks S
BS
Edwards
Alfredo L
AL
Clavell
Richard J
RJ
Rodeheffer
Robert P
RP
Frantz
Manish J
MJ
Gandhi
Simon
S
Maltais
Soon J
SJ
Park
Richard C
RC
Daly
Amir
A
Lerman
Sudhir S
SS
Kushwaha
D000328:Adult; D000368:Aged; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology; D016016:Proportional Hazards Models; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods; D014652:Vascular Diseases / Q000209:etiology / Q000628:therapy*