Coronary arteriographie findings in cardiac transplant recipients
James F. Silverman, M.D.
Edward B. Stinson, M.D.
Charles P. Bieber, M.D.
Lewis Wexler, M.D.
Coronary arteriography is performed routinely on a yearly basis in cardiac transplant recipients at Stanford University Hospital. It is the only method available to determine the status of the coronary arteries in this unusual group of denervated, angina-free patients. Since coronary artery disease is a leading cause of late death in cardiac transplant recipients, the coronary arteriograms have become important diagnostic and prognostic tests.
As of 1979, 174 cardiac transplants have been performed in 161 patients. The number per year has increased steadily from 10 to 15 in earlier years to 31 in 1978. This increase is due in part to the availability of donor hearts. Hearts can be removed and cooled in one city and then transported to Stanford by air for insertion in an appropriate recipient. In this group of 161 patients, there were 74 one-year survivors (91% rehabilitated) and 67 are still alive (one week to 9 years). The current one-year survival rate is 65%; 50% survive for 5 years.
There were 178 coronary arteriograms performed in patients surviving at least one year. Seventy-one patients had 127 normal studies and 18 patients had a total of 51 abnormal studies with findings of coronary artery disease. In the latter group, seven arteriograms were abnormal at the first study; 11 were normal initially, but later became abnormal: seven in the second, three in the third, and one in the fourth year. Evaluation of this 18-patient cohort yielded the following correlations with accelerated coronary artery disease.
Factors not affecting were . . .