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

J Heart Lung Transplant. 2020 Nov;39(11):1260-1269. doi: 10.1016/j.healun.2020.08.003. Epub 2020 Aug 8.


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.

Keywords: angiography; coronary allograft vasculopathy; heart transplant; pediatrics; screening.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Allografts
  • Child
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / epidemiology*
  • Female
  • Heart Transplantation / adverse effects*
  • Humans
  • Incidence
  • Male
  • Population Surveillance / methods*
  • Survival Rate / trends