Multicenter Retrospective Analysis of Cardiovascular Risk Factors Affecting Long-term Outcome of De Novo Cardiac Transplant Recipients

Jon A. Kobashigawa, Randall C. Starling, Mandeep R. Mehra, Robert L. Kormos, Geetha Bhat, Mark L. Barr, Chris S. Sigouin, June Kolesar, William Fitzsimmons

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Abstract

Background: Previous risk factor studies in cardiac transplant patients have analyzed pre-transplant risk factors as they relate to outcomes. This study is the first in-depth multicenter assessment of ongoing post-transplant risk factors in heart transplant patients and their impact on 5-year outcomes. Methods: We reviewed 280 heart transplant patients who survived >1 year for the impact of post-transplant risk factors (hyperlipidemia, hypertension, diabetes, body mass index [BMI] and renal dysfunction: 8 to 18 possible measurements over 5 years) on outcomes, including death, cardiac allograft vasculopathy (CAV) and non-fatal major adverse cardiac events (NF-MACE). Results: Upon multivariate Cox regression analysis, significant findings were high total-cholesterol for NF-MACE (relative risk [RR] = 4.34, confidence interval [CI] 1.35 to 13.98, p = 0.01), presence of diabetes for NF-MACE (RR = 3.96, CI 1.24 to 12.65, p = 0.02) and high serum creatinine for graft death (RR = 1.59, CI 1.35 to 1.87, p < 0.001). No covariates were found to be significant for CAV. Other significant risk factors by univariate Cox regression models with time-dependent covariates included BMI ≥33 for graft death. Conclusions: Post-transplant risk factors of hypercholesterolemia and diabetes are associated with NF-MACE, whereas high serum creatinine and BMI ≥33 are associated with graft death. Risk factor modification, including direct therapy to minimize risk factors, should be considered.

Original languageEnglish (US)
Pages (from-to)1063-1069
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume25
Issue number9
DOIs
StatePublished - Sep 1 2006

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Kobashigawa, J. A., Starling, R. C., Mehra, M. R., Kormos, R. L., Bhat, G., Barr, M. L., Sigouin, C. S., Kolesar, J., & Fitzsimmons, W. (2006). Multicenter Retrospective Analysis of Cardiovascular Risk Factors Affecting Long-term Outcome of De Novo Cardiac Transplant Recipients. Journal of Heart and Lung Transplantation, 25(9), 1063-1069. https://doi.org/10.1016/j.healun.2006.05.001