*Purpose: Ischemia reperfusion injury (IRI) is not uncommon in heart transplant patients due to high dose inotropes, ischemic time, and technical surgical reasons. Ischemia in the donor heart is most likely associated with an inflammatory response (response to injury) and possibly contributing to endothelial cell dysfunction. Heart biopsy in the first 2 months after heart transplant can be assessed for IRI by noting areas of ischemia. We sought to assess whether ischemia on heart biopsy in the first two months after transplant correlates to the change in first-year intimal thickness by intravascular ultrasound (IVUS).

*Methods: Between 2010 and 2017 we assessed 90 heart transplant patients who were noted to have ischemia on their endomyocardial biopsy within the 2 months after heart transplantation. These patients were compared to patients without ischemia noted on endomyocardial biopsy (n=193). All patients had IVUS performed at baseline (within 8 weeks post-transplant) and compared to IVUS at 1 year. The change in intimal thickness (maximal intimal thickness (MIT)) was calculated for all patients. Clinical outcomes included 1-year freedom from rejection (any treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR)) and non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, percutaneous coronary intervention/angioplasty, new congestive heart failure, pacemaker/implantable cardioverter-defibrillator placement, stroke).

*Results: Patients who developed IRI on heart biopsy appear to have greater freedom from ATR than patients who did not develop IRI. There was no difference between patients with and without IRI on heart biopsy in terms of intimal thickening in the first year after heart transplantation.

*Conclusions: IRI does not appear to be correlated to the development of first-year intimal thickening after heart transplantation. Understanding of why there is less rejection in the IRI group will be pursued.

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