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The Use Of First-year Intravascular Ultrasound In The Tacrolimus Era In Heart Transplantation

S. Dimbil1, M. Kittleson1, J. Patel1, D. Geft1, R. Cheng1, R. Levine1, T. Sato1, L. Czer1, R. Zabner2, P. Zakowski2, J. A. Kobashigawa1, B. Azarbal1

1Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, 2Cedars-Sinai Medical Center, Los Angeles, CA

Meeting: 2019 American Transplant Congress

Abstract number: B111

Keywords: Cytomeglovirus, Heart

Session Information

Session Name: Poster Session B: Heart and VADs: All Topics

Session Type: Poster Session

Date: Sunday, June 2, 2019

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Cytomegalovirus (CMV) has been documented as a risk factor for the development of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). It has not been firmly established whether CMV would cause an increase in first-year intimal thickening via intravascular ultrasound (IVUS) in the current tacrolimus era. First-year maximal intimal thickening (MIT) ≥0.5mm has been found to be predictive of poor outcome (worse survival, CAV) at 5-years post-transplant. In addition, there has not been a differentiation between CMV infection, CMV syndrome, and CMV disease as it applies to IVUS intimal thickening. CMV infection is noted by positive IgG CMV serology only; CMV syndrome refers to patients with documented CMV virus along with a clinical presentation; CMV disease is defined as organ-specific CMV infection i.e. CMV pneumonitis, CMV colitis etc. Therefore, we sought to use first-year IVUS to determine whether CMV infection, syndrome, or disease would lead to more first-year MIT ≥0.5mm.

*Methods: Between 2010 and 2017, 294 heart transplant patients underwent baseline and 1-year IVUS. These patients were then divided into 4 groups: (Group A – no CMV infection (n=108); Group B – CMV infection (n=173); Group C – CMV syndrome (n=9); and Group D – CMV disease (n=3)). Diagnosis of CAV was based on a ≥ 0.5 mm increase in maximal intimal thickness (MIT) from baseline.

*Results: Baseline MIT was similar among all study groups. The percent of patients with first-year MIT ≥0.5mm was also similar among all patient groups.

*Conclusions: The development of CMV infection, syndrome and disease, does not appear to increase CAV risk by first-year MIT obtained by IVUS in the current tacrolimus era. Larger number of patients with longer follow-up studies are warranted to confirm these findings.

Endpoints Group A (n=108) Group B (n=173) Group C (n=9) Group D (n=3) P-Value
Mean Baseline MIT (mm) ± SD 0.4 ± 0.4 0.4 ± 0.4 0.4 ± 0.4 0.3 ± 0.4 0.292
Mean 1-Year MIT (mm) ± SD 0.7 ± 0.6 0.6 ± 0.5 0.6 ± 0.6 0.5 ± 0.5 0.395
Δ MIT ≥ 0.5 mm, % 19.4% 24.4% 22.2% 33.3% 0.399
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To cite this abstract in AMA style:

Dimbil S, Kittleson M, Patel J, Geft D, Cheng R, Levine R, Sato T, Czer L, Zabner R, Zakowski P, Kobashigawa JA, Azarbal B. The Use Of First-year Intravascular Ultrasound In The Tacrolimus Era In Heart Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-use-of-first-year-intravascular-ultrasound-in-the-tacrolimus-era-in-heart-transplantation/. Accessed June 1, 2025.

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