title: Comparison of cardiac allograft vasculopathy in heart and heart-lung transplantations: a 15-year retrospective study.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) is a major factor limiting long-term survival after heart transplantation (HTx). Specific determinants of CAV and long-term outcome after CAV occurrence have been poorly investigated after heart-lung transplantation (HLTx).
  
  
  METHODS
  Between January 1996 and December 2006, 79 patients underwent HLTx (36.3 ± 12.2 years old; 47% men) and 141 patients underwent HTx (49.2 ± 12.3 years old; 77% men) at two different institutions. CAV grading was reviewed in both groups according to the 2010 standardized nomenclature of the International Society for Heart and Lung Transplantation. The mean post-transplant follow-up was 94 (1 to 181) months.
  
  
  RESULTS
  Overall 10-year survival rate was 58% after HTx and 43% after HLTx (p = 0.11). The Grade 1 (or higher) CAV-free survival rate was 95% at 4 years and 69% at 10 years after HLTx, and 77% and 39%, respectively, after HTx (p < 0.01). Mean cyclosporine blood levels were similar between the groups at 3, 6, 12, 24 and 36 months. The main causes of mortality beyond 5 years after HTx and HLTx were malignancies and bronchiolitis obliterans, respectively. By multivariate analysis, recipients who developed >3 acute myocardial rejections during the first year post-transplant were exposed to a higher risk of CAV (95% CI 1.065 to 2.33, p = 0.02). Episodes of acute pulmonary rejection and bronchiolitis obliterans were not associated with an increased risk of CAV (p = 0.52 and p = 0.30).
  
  
  CONCLUSIONS
  HLTx recipients appeared protected from CAV compared with HTx patients in this retrospective study. Repeated acute cardiac rejections were independent predictors of CAV. Unlike bronchiolitis obliterans, CAV had a very low impact on long-term survival after HLTx.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes. Electronic address: julien.guihaire@u-psud.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Guihaire
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France.
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flécher
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Marie
authors.initials: M
authors.lastname: Aymami
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France.
authors.forename: Soly
authors.initials: S
authors.lastname: Fattal
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Céline
authors.initials: C
authors.lastname: Chabanne
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Leroy Ladurie
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cerrina
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Thierry
authors.initials: T
authors.lastname: Langanay
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France.
authors.forename: Sacha
authors.initials: S
authors.lastname: Mussot
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Fabre
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Bertrand
authors.initials: B
authors.lastname: De Latour
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Hervé
authors.initials: H
authors.lastname: Corbineau
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dartevelle
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital of Rennes, University of Rennes 1, Rennes.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D016041:Heart-Lung Transplantation; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011660:Pulmonary Heart Disease / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: cardiac allograft vasculopathy; heart–lung transplantation; immune tolerance; long-term outcomes