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Impact of donor-transmitted coronary atherosclerosis on quality of life (QOL) and quality-adjusted life years (QALY) after heart transplantation

O. Grauhan1, H. Huang Chang2, W. Albert1, N. Hiemann1, R. Meyer1, H. Lehmkuhl1, M. Dandel1, C. Knosalla1, M. Hübler1, M. Pasic1, Y.-G. Weng1, R. Hetzer1
1Deutsches Herzzentrum Berlin, Berlin, Germany; 2Taipei Veterans General Hospital, Taipei, Taiwan
[Applied Cardiopulmonary Pathophysiology 14: 58-65, 2010]


Background: In 5-10% of HTX significant coronary artery sclerosis is transmitted. This study evaluates the impact of donor-transmitted coronary artery sclerosis (DCAS) on quality of life (QOL) and quality-adjusted life years (QALY) after transplantation.
Methods: In 1253 consecutive transplantations single-vessel DCAS was found in 53 patients (DCAS1 group) and double- or triple-vessel DCAS in 26 patients (DCAS2/3 group). Health-related QOL was analyzed by the “Short-Term Inventory 36 Health Survey” (SF-36) scale and QALY were calculated. Patients without DCAS, who were matched for sex, age, indication and time after transplantation, served as controls (NDCAS).
Results: Thirty-day mortality in groups NDCAS, DCAS1 and DCAS2/3 was 12.2%, 13.2% and 61.5%, respectively. However, beyond the first year the annual decrease in all groups was comparable (5.4%/year, 4.3%/year, and 5.0%/year). The SF-36 questionnaire showed no significant differences between the groups in the long-term survival. Quality-adjusted life years were comparable in groups NDCAS (8.0 QALY) and DCAS1 (8.5 QALY) but worse in DCAS2/3 (2.2 QALY).
Conclusions: DCAS represents a risk for early graft failure but impairs neither long-term survival thereafter nor quality of life (QOL). Donor screening by angiography seems to be a good investment to avoid the loss of about 6 quality-adjusted life years (QALY) by transmitted coronary atherosclerosis.

Key words: coronary atherosclerosis, heart donor, quality of life, quality adjusted life years, QALY, heart transplantation

Address for corresponding:
Onnen Grauhan, M.D., Ph.D., Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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