Identification of Preoperative Risk Factors for the Development of Cardiac Allograft Vasculopathy: A Systematic Review

The purpose of this systematic review was to analyze the current literature and identify all known preoperative risk factors associated with an increased incidence of cardiac allograft vasculopathy.

A total of 7 independent preoperative risk factors for cardiac allograft vasculopathy were identified, namely T. gondii seropositivity (HR 4.39, 1.26–15.62, p < 0.02), elevated body mass index (HR 1.116, 1.015–1.23, p < 0.02), 2–1 haptoglobin phenotype (HR 2.73, 1.03–7.19, p < 0.01), elevated low-density lipoproteins (OR 2.14, 1.02–4.46, p < 0.04), single-nucleotide polymorphism -201 matching (HR 11.9, 4.3–32.9, p < 0.01), stroke cause of death (HR 1.47, 1.04–2.09, p < 0.03), and pre-transplant hemodynamic instability (HR 1.79, 1.15–2.77, p < 0.01).

Cardiac allograft vasculopathy is the leading cause of death in patients who survive more than a few years following transplantation and is likely the limiting factor in expanding the average life expectancy post-transplant. The development of therapeutics targeting the multifactorial etiology of this vasculopathy would undoubtedly provide hope for patients whose time is currently limited.