*Purpose: Coronary allograft vasculopathy (CAV) continues to be a common cause of morbidity and mortality in heart transplant recipients. Little is known about the timing of onset or progression of CAV after heart transplantation (HTx), or its relationship to donor acquired disease. We sought to assess the incidence of donor acquired disease and impact on disease progression in the first year post transplant.

*Methods: We retrospectively analyzed consecutive HTx recipients at our center between January 2016 and December 2017, who underwent coronary angiography and intravascular ultrasound (IVUS) at 6 weeks (baseline) and 1 year after HTx. We assigned patients to one of 2 groups: Group 1 were those who had baseline ISHLT CAV≥1 or MIT≥0.5mm. Group 2 were those patients with CAV0 or MIT< 0.5mm. At one year, progression of CAV was defined as worsening of CAV class or MIT increase beyond 0.5mm. We used Fisher Exact test to analyze the impact of baseline disease on likelihood of progression.

*Results: A total of 87 patients were identified, mean age 59.4 (+/- 12.6), 77 % male, 36 % ischemic etiology. Table 1. Twenty patients had baseline disease, while 67 did not. Between baseline and 1 year post-HTx, CAV developed in 18 patients in group 1 and 7 patients in group 2 (P-value <0.001) Figure 1. Two patients died prior to 1 year, and of note both patients had MIT≥0.5mm in their baseline IVUS.

*Conclusions: In our small single center study, we found that donor derived non-angiographic coronary disease is fairly common. Furthermore, CAV seems to progress in the first year significantly more in patients with baseline pre-existing disease than in those without. Further study is warranted to validate these findings and delineate clinical significance.

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