Introduction: Cardiac allograft vasculopathy (CAV) remains a leading cause of late graft loss after heart transplantation (HTx) and results from complex immune- and non-immune-mediated pathways, each contributing to endothelial dysfunction. (1-3)

Patients and Methods: We performed a retrospective registry-based analysis of HTx recipients who underwent CAV assessment by coronary angiography between January 2010 and January 2018 at the University Hospital Centre Zagreb. Baseline donor and recipient characteristics were collected, along with recipient clinical parameters at 1 and 3 years following HTx. The objective was to identify risk factors for CAV at 3 years.

Results: Among 126 heart transplant recipients, CAV was present in 38 patients (30%) at 3 years; 25 (65.8%) were male. The CAV group had a higher mean donor age (46.7 ± 8.7 years). Recipient history of coronary artery disease (CAD) and donor age >45 years were independently associated with increased CAV risk. CAD history conferred a 3.6-fold higher risk (HR = 3.61, 95% CI: 1.59–8.22, p = 0.002), and donor age >45 was associated with a 3.7-fold increased risk (HR = 3.72, 95% CI: 1.64–8.45, p = 0.002) (Figure 1). No other baseline characteristics or recipient cardiovascular risk factors at 1 and 3 years were significantly different between groups (Figures 2 and 3).

Conclusion: Recipient CAD history and donor age >45 years were significantly associated with CAV development at 3 years after HTx. These results are consistent with prior studies and underscore the importance of donor-recipient risk profiling to improve prediction of post-HTx outcomes and may warrant more intensive prevention measures.