Surveillance for cardiac allograft vasculopathy: Practice variations among 50 pediatric heart transplant centers

Deipanjan Nandi, Clifford Chin, Kurt R. Schumacher, Matthew Fenton, Rakesh K. Singh, Kimberly Y. Lin, Jennifer Conway, Ryan S. Cantor, Devin A. Koehl, Jacqueline M. Lamour, James K. Kirklin, Elfriede Pahl

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Coronary allograft vasculopathy (CAV) is a leading cause of mortality after heart transplantation (HT) in children. Variation in CAV screening practices may impact detection rates and patient outcomes. METHODS: Among 50 Pediatric Heart Transplant Society (PHTS) sites from 2001 to 2016, coronary evaluations were classified as angiography or non-invasive testing, and angiograms were designated as routine or symptom based. CAV detection rates stratified by routine vs symptom-based angiograms were calculated. Freedom from CAV and mortality after CAV diagnosis, stratified by study indication, were calculated. RESULTS: A total of 3,442 children had 13,768 coronary evaluations; of these, 97% (n = 13,012) were for routine surveillance, and only 3% (n = 333) were for cause. Over the study period, CAV was detected in 472 patients (14%). Whereas 58% (n = 29) of PHTS sites evaluate by angiography alone, 42% reported supplementing with a non-invasive test, although only 423 non-invasive studies were reported. Angiographic detection of CAV was higher for symptom-based testing than for routine testing (29% vs 4%, p < 0.0001), although routine testing identified a majority of cases (88%; n = 414). The 10-year freedom from CAV was 77% overall. Once CAV is detected, 5-year graft survival was 58%, with lower survival for patients diagnosed after symptoms angiogram than after routine angiogram (30% vs 62%; p < 0.0001). CONCLUSIONS: Development of a robust model for CAV risk should allow low-risk patients to undergo less frequent invasive angiography without adverse impact on CAV detection rates or outcomes.

Original languageEnglish (US)
Pages (from-to)1260-1269
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number11
DOIs
StatePublished - Nov 2020

Keywords

  • angiography
  • coronary allograft vasculopathy
  • heart transplant
  • pediatrics
  • screening

ASJC Scopus subject areas

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

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