Prognostic assessment of transplant vasculopathy after heart transplantation

• Applicant: Privatdozentin Dr. Nicola E. Hiemann
• Subject Area: Cardiac and Vascular Surgery
• Term: from 2009 to 2012
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 92075294

For several decades transplantat vasculopathy (TVP) has been recognized as a major cause of death in the long-term follow-up after heart transplantation. However, “international standards” do not corroborate current practices of diagnostic follow-up for TVP, i.e. selection of patients for assessment, time points of investigation post-transplant, diagnostic tool(s) and grading schedules for epicardial and microvascular TVP. To date, data available concerning onset, degree and morphologic structures affected differ substantially and anticipate validation of etiopathogenetic and therapeutic approaches. In 2003 we initiated a study to validate prospectively morphologic and functional criteria for invasive and non-invasive assessment of epicardial and microvascular TVP. We included 78 patients who were scheduled for follow-up examinations at 4 weeks (study completed), 1 (study completed 03/08), 3 (to complete 06/09) and 5 years post-transplant (to complete 06/11) and 17/29 long-term survivors (>5 years) without severe epicardial TVP. We found vascular alterations in all transplanted hearts but these were not mandatorily associated with poor clinical or functional findings of coronary or myocardial performance. Microvascular and epicardial TVP do correlate; however, surrogate markers indicating the level and degree of vascular involvement especially with regard to long-term follow-up are unknown and deserve further study.

• DFG Programme: Research Grants