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Simvastatin treatment in heart transplant recipients decreases myocardial tumor necrosis factor α content
90
Abstracts
The Journal of Heart and Lung Transplantation January 2002
underwent kidney transplantation at 101⫾45 months after HTx. Types of malignancy were: lymphoma in 7.7%(103⫾50 months), non-lymphoid malignancy 32.2%(96⫾45 months): skin cancer 28.7%, solid organ cancer 7.0%. Thirty five patients(24.5%) had significant angiographic CAD(⬎50% stenosis in a main epicardial artery) at mean of 90⫾40 months after HTx and 15(10.5%) had angioplasty ⫹/- stenting. Forty two of the patients(29.4%) have died and main causes of death were graft CAD (31.0%) and malignancy (30.9%). Two(1.4%) patients underwent re-HTx. Conclusion: Patients who survived beyond 10 years after HTx on a CsA-based regimen mostly have excellent functional status. However, renal dysfunction, malignancy and graft CAD remain clinical threats to them.
98 B-TYPE NATRIURETIC PEPTIDE AND PEAK AEROBIC CAPACITY: INSIGHTS INTO ALLOGRAFT DETERMINANTS OF EXERCISE LIMITATIONS FOLLOWING HEART TRANSPLANTATION M.R. Mehra, P.A. Uber, M.H. Park, R.L. Scott, Cardiomyopathy and Heart Transplantation Center, Ochsner Clinic Foundation, New Orleans, LA Background: Peak aerobic capacity (VO2) remains limited after transplantation in the majority of recipients. Whether, this limitation is due to ineffective allograft circulatory responses in a dennervated organ or due to peripheral limitations in working muscles, remains a matter of controversy. Methods: To elucidate the contribution of cardiac allograft function on peak VO2, we measured B-Type Natriuretic Peptide (BNP) levels, a sensitive and specific marker of ventricular wall stress, in 12 consecutive heart transplant recipients who underwent cardiopulmonary exercise testing. Correlations with demographic factors, resting hemodynamics, echocardiographic structural indices, renal function, time post-transplant and immunosuppression were conducted. Results: The mean age was 60 ⫾ 5 years and average VO2 was 16.5 ⫾ 3.7 cc/kg/min. Bivariate analysis revealed that BNP levels, moderate to severe tricuspid regurgitation (TR), left ventricular ejection fraction (LVEF) and presence of right ventricular dysfunction (RVD) were significant predictors of peak VO2 as shown in the table below. Variable
r value
p value
BNP level LVEF TR RVD
0.6 0.4 0.7 0.5
0.03 0.02 0.008 0.04
In stepwise regression analysis for predictors of BNP levels, peak VO2 (negative correlation) and prednisone dose (positive correlation) fit the model best (p0.003), while ejection fraction, creatinine and right ventricular dysfunction fell out of the model. Conclusion: This investigation establishes the close association of exercise limitations after heart transplantation with B-Type Natriuretic Peptide, an accurate index of cardiac allograft overload. Furthermore, these findings allude to an important association of right ventricular dysfunction and tricuspid regurgitation in determining peak aerobic capacity. Thus, we have confirmed the sentinal contribution of the allograft in determining exercise limitations following transplantation.
99 CLINICAL APPLICATION OF MONITORING MYCOFENOLIC ACID (MPA) CONCENTRATION IN HEART TRANSPLANT RECIPIENTS - PRELIMINARY REPORT M. Zakliczynski, M. Szewczyk, M. Zembala, Department of Cardiac Surgery and Transplantation, Silesian Centre for Heart Disease, Zabrze, Poland A purpose of this study was to evaluate clinical application of mycofenolic acid (MPA) plasma concentration monitoring in heart transplant recipients and to identify factors influencing metabolism of MPA. Methods: We reviewed 456 results of MPA plasma level measurement (EMIT/ Dade-Behring) performed in 78 pts. after heart transplantation (OHT): 57M, 21F, age 41.8 (1.8-68), time after OHT 19.3 moths (1-164). Dose of MMF was 1g bid before MPA measurement introduction, than it was driven by MPA levels with target trough level (TL) ranged 2-4ug/ml. Additionally patients received either cyclosporine-A (CyA) or tacrolimus and prednisone. We performed analysis of first MPA level obtained in patients that received MMF without previous MPA control, than we analyzed influence of CyA and tacrolimus on MPA level, finally we compared MPA levels in early and late phase after transplantation. Results: In a group of 59 pts. receiving MMF without earlier MPA level control we found that 36 pts. (61%) had MPA level below therapeutic range (TR), 19 pts. (32%) had MPA level within TR, and 4 pts. (7%) had MPA levels over TR. Analyzing all results we found non-significant negative correlation between CyA and MPA concentration. However we identified a group of 11 pts. with significant positive correlation between CyA and MPA level, which was characterized by unstable CyA concentration and impairment of hepatic function. Further analysis was performed with exclusion of this group. Therapeutic level of MPA was achieved in 53% of cases in pts. with CyA TL below 200ng/ml (Axsym/ Abbott), in 49% of cases in pts with CyA TL 200-300ng/ml, and in 38% of cases in pts. with CyA TL over 300 ng/ml. There was no correlation between tacrolimus and MPA level, with TR of MPA achieved in 55% of cases. Considering time after OHT TR of MPA was achieved in 43% of cases during first 3 months after OHT, in 38% of cases during months 4-12 after OHT, and in 56% of cases in patients who completed 1st year after OHT. Conclusion: Many heart transplant recipients receiving MMF do not achieve therapeutic level of MPA, especially with concomitant use of high doses of CyA and in early period after transplantation. 100 SIMVASTATIN TREATMENT IN HEART TRANSPLANT RECIPIENTS DECREASES MYOCARDIAL TUMOR NECROSIS FACTOR ␣ CONTENT S.J. Stetson,1 J.A. Farmer,1 S.C. McRee,1 K.A. Becker,1 M.M. Koerner,1 G.P. Noon,2 G. Torre-Amione,1 1Medicine Cardiology, Baylor College of Medicine, Houston, TX; 2Surgery Transplant Division, Baylor College of Medicine, Houston, TX There are increasing experimental support for the use of statins following cardiac transplantation. Since the clinical benefits observed are not related to their effect on lipids; the effects of statins my be at least partially related to down regulation of
The Journal of Heart and Lung Transplantation Volume 21, Number 1 various immune responses involved in the allograft response. Tumor Necrosis Factor-␣ is a cytokine produced in cardiac allografts and capable of producing hypertrophy and fibrosis. To further define the beneficial effects of statins in heart trasplant recipients, we conducted a prospective randomized controlled study to evaluate the effect of simvastatin on myocardial (m)TNF␣ expression. Ten patients were randomized to receive simvastatiin 20 mg/day (n⫽5) or no therapy (n⫽5), for 6 months following cardiac transplantation. Myocardial TNF␣ and markers of hypertrophy were measured by semi-quantative immunohistochemistry. We found that 1 week post-transplant mTNF content was similar among the simvastatin treated patients and controls (15⫾2.3% tissue area stained vs 15⫾1.5% tissue area stained, respectively, p⫽ns). At 24 weeks post transplant there was a significant reduction in mTNF content in simvastatin treated patients (5.8⫾2.4% tissue area stained, p⫽0.02) whereas there was no change in the controls (12⫾2.6% tissue area stained, p⫽ns). At 24 weeks total collagen content was 21⫾5.7% tissue area stained, in simvastatin treated patients and 25⫾4.7% tissue area stained, in controls (p⫽ns). At 24 weeks myocyte size was 21⫾3.6 microns in simvastatin treated patients and 21⫾0.8 microns in controls. These data indicate that heart transplant recipients treated with simvastatin have lower levels of mTNF that controls. The reduction in mTNF occurred in the absence of a decrease in markers of hypertrophy. We suggest that the beneficial effects of simvastatin in heart transplant recipients may in part be explained by the reduction in mTNF. 101 TRICUSPID VALVE ANNULOPLASTY SIGNIFICANTLY REDUCES EARLY TRICUSPID REGURGITATION AFTER BIATRIAL HEART TRANSPLANTATION A.M. Borkon, N.E. Brown, G.F. Muehlebach, M.E. Gorton, R.S. Stuart, Cardiovascular Surgery, MidAmerica Heart Institute, Kansas City, MO Purpose: Tricuspid Regurgitation (TR) early after cardiac transplant (CTX) may delay recovery, predispose to late right ventricular dysfunction, and ultimately reduce the functional benefit of CTX. The incidence of TR after CTX using biatrial implantation is unpredictable and not infrequently problematic. Although bicaval CTX may reduce the incidence of TR, it can be technically demanding and occasionally associated with caval stenosis. Methods: In an attempt to reduce the incidence of TR observed early after CTX, 25 consecutive patients (PTS) undergoing CTX received donor heart tricuspid annuloplasty (TA). PTS demographics, clinical characteristics, outcomes and early transthoracic echocardiograms were analyzed and compared to an immediately prior and consecutive cohort of 25 PTS undergoing CTX without TA. The biatrial technique of CTX with Cabrol modification was used for donor heart implant in both groups. Echocardiograms were obtained 5 days after CTX and reviewed in blinded fashion. TR was scored 0⫽none, 1⫽mild, 2⫽moderate and 3⫽severe. Results: Donor and recipient characteristics including age, ischemic time, recipient status, and pulmonary vascular resistance were not different between groups. No hospital deaths occurred in either group. CTX without TA had a higher TR score, 1.3 (range 0-3) than CTX with TA, score⫽0.7 (range 0-1.5, P⬍0.05). Moderate or severe TR was present in 8/25 PTS without TA compared to 0/25 PTS with TA (P⬍0.05). Postoperative length of stay was similar for both groups and no PTS required permanent pacemaker.
Abstracts
91
Conclusions: TA can significantly reduce the incidence of early postoperative TR without adding to the complexity of operation. 102 HYPERIMMUNE IVIG MAY BE ADVANTAGEOUS IN COMPARISON TO INTRAVENOUS GANCICLOVIR AS A PREEMPTIVE ANTIVIRAL THERAPY IN CMV-POSITIVE HEART TRANSPLANT RECIPIENTS C.D. Thomas, R. Radovancevic, E.L. Ford, B. Radovancevic, O.H. Frazier, Transplant Service, Texas Heart Institute, Houston, TX Introduction: We compared the effectiveness of preemptive antiviral therapy for prevention of CMV disease using hyperimmune IVIG (Cytogam威; Medimmune) versus intravenous ganciclovir (Cytovene威; Roche Pharmaceuticals) in CMV-positive heart transplant recipients. In a prospective randomized trial, we analyzed data from 18 adult patients who underwent primary heart transplantation from 1997 to 2000. Methods: Peripheral blood leukocytes (PBL) from all 18 patients were assayed by means of CMV pp65 antigenemia assay detected and fluorescent microscopy. The assay, which utilized FITClabeled monoclonal antibodies to CMV lower-matrix protein pp65, was performed weekly for 12 weeks. A positive result was defined as ⬎1 antigen-positive cell per 5x104 PBL. Those patients who received a positive response (Group I, n ⫽ 8 ) received Cytogam威 200 mg/kg IV (Medimmune). The other 10 patients (Group II) received ganciclovir intravenously (IV) 5 mg/kg every 12 hours for 7 days. CMV disease was defined as a positive tissue culture, positive PCR tissue analysis, febrile illness involving a four-fold increase in the CMV IgG level and/or the presence of CMV IgM in the absence rheumatoid factor, or at least two of the following–(1) doubling of SGOT or LDH level, (2) leukopenia (⬍4000 cells/ml), and (3) thrombocytopenia (⬍100,000 cells/ml). Results: The groups were comparable in regard to pretransplant and donor CMV status, immunosuppressive therapy, and incidence of rejections. On average, Group I patients converted to positive antigenemia on day 41 (range, 26-58 days) and Group II patients on day 37.3 (range, 30-43) (p⫽NS). No patients from either group developed CMV disease. The average charge for 1 week of therapy (drug, line placement, and nursing) was $3100 for Group I versus $3600 for Group II. Conclusion: Both arms of this study were effective in preventing development of CMV disease. However, due to its ease of administration and potentially lesser risk of infection from an indwelling line, the Cytogam威 approach appears to be more advantageous. 103 SHRINKAGE OF ALLOGRAFT ARTERIES OCCURS FREQUENTLY AFTER TRANSPLANTATION AND IS ACCOMPANIED WITH PLAQUE SHRINKAGE S.A. Haji, M.H. Yamani, R.C. Starling, P. Schoenhagen, T.D. Crowe, J.B. Young, E.M. Tuzcu, Cardiology, Cleveland Clinic Foundation, Cleveland, OH Background: Both positive and negative arterial remodeling has been described early after transplantation. We sought to determine the relationship between remodeling and the pattern of dynamic plaque changes in the first year after transplantation. Methods: We examined 66 consecutive patients at 1 month and one year after transplantation with serial Intravascular Ultrasound (IVUS), using an automated pullback system (0.5mm/sec).
Abstracts
The Journal of Heart and Lung Transplantation January 2002
underwent kidney transplantation at 101⫾45 months after HTx. Types of malignancy were: lymphoma in 7.7%(103⫾50 months), non-lymphoid malignancy 32.2%(96⫾45 months): skin cancer 28.7%, solid organ cancer 7.0%. Thirty five patients(24.5%) had significant angiographic CAD(⬎50% stenosis in a main epicardial artery) at mean of 90⫾40 months after HTx and 15(10.5%) had angioplasty ⫹/- stenting. Forty two of the patients(29.4%) have died and main causes of death were graft CAD (31.0%) and malignancy (30.9%). Two(1.4%) patients underwent re-HTx. Conclusion: Patients who survived beyond 10 years after HTx on a CsA-based regimen mostly have excellent functional status. However, renal dysfunction, malignancy and graft CAD remain clinical threats to them.
98 B-TYPE NATRIURETIC PEPTIDE AND PEAK AEROBIC CAPACITY: INSIGHTS INTO ALLOGRAFT DETERMINANTS OF EXERCISE LIMITATIONS FOLLOWING HEART TRANSPLANTATION M.R. Mehra, P.A. Uber, M.H. Park, R.L. Scott, Cardiomyopathy and Heart Transplantation Center, Ochsner Clinic Foundation, New Orleans, LA Background: Peak aerobic capacity (VO2) remains limited after transplantation in the majority of recipients. Whether, this limitation is due to ineffective allograft circulatory responses in a dennervated organ or due to peripheral limitations in working muscles, remains a matter of controversy. Methods: To elucidate the contribution of cardiac allograft function on peak VO2, we measured B-Type Natriuretic Peptide (BNP) levels, a sensitive and specific marker of ventricular wall stress, in 12 consecutive heart transplant recipients who underwent cardiopulmonary exercise testing. Correlations with demographic factors, resting hemodynamics, echocardiographic structural indices, renal function, time post-transplant and immunosuppression were conducted. Results: The mean age was 60 ⫾ 5 years and average VO2 was 16.5 ⫾ 3.7 cc/kg/min. Bivariate analysis revealed that BNP levels, moderate to severe tricuspid regurgitation (TR), left ventricular ejection fraction (LVEF) and presence of right ventricular dysfunction (RVD) were significant predictors of peak VO2 as shown in the table below. Variable
r value
p value
BNP level LVEF TR RVD
0.6 0.4 0.7 0.5
0.03 0.02 0.008 0.04
In stepwise regression analysis for predictors of BNP levels, peak VO2 (negative correlation) and prednisone dose (positive correlation) fit the model best (p0.003), while ejection fraction, creatinine and right ventricular dysfunction fell out of the model. Conclusion: This investigation establishes the close association of exercise limitations after heart transplantation with B-Type Natriuretic Peptide, an accurate index of cardiac allograft overload. Furthermore, these findings allude to an important association of right ventricular dysfunction and tricuspid regurgitation in determining peak aerobic capacity. Thus, we have confirmed the sentinal contribution of the allograft in determining exercise limitations following transplantation.
99 CLINICAL APPLICATION OF MONITORING MYCOFENOLIC ACID (MPA) CONCENTRATION IN HEART TRANSPLANT RECIPIENTS - PRELIMINARY REPORT M. Zakliczynski, M. Szewczyk, M. Zembala, Department of Cardiac Surgery and Transplantation, Silesian Centre for Heart Disease, Zabrze, Poland A purpose of this study was to evaluate clinical application of mycofenolic acid (MPA) plasma concentration monitoring in heart transplant recipients and to identify factors influencing metabolism of MPA. Methods: We reviewed 456 results of MPA plasma level measurement (EMIT/ Dade-Behring) performed in 78 pts. after heart transplantation (OHT): 57M, 21F, age 41.8 (1.8-68), time after OHT 19.3 moths (1-164). Dose of MMF was 1g bid before MPA measurement introduction, than it was driven by MPA levels with target trough level (TL) ranged 2-4ug/ml. Additionally patients received either cyclosporine-A (CyA) or tacrolimus and prednisone. We performed analysis of first MPA level obtained in patients that received MMF without previous MPA control, than we analyzed influence of CyA and tacrolimus on MPA level, finally we compared MPA levels in early and late phase after transplantation. Results: In a group of 59 pts. receiving MMF without earlier MPA level control we found that 36 pts. (61%) had MPA level below therapeutic range (TR), 19 pts. (32%) had MPA level within TR, and 4 pts. (7%) had MPA levels over TR. Analyzing all results we found non-significant negative correlation between CyA and MPA concentration. However we identified a group of 11 pts. with significant positive correlation between CyA and MPA level, which was characterized by unstable CyA concentration and impairment of hepatic function. Further analysis was performed with exclusion of this group. Therapeutic level of MPA was achieved in 53% of cases in pts. with CyA TL below 200ng/ml (Axsym/ Abbott), in 49% of cases in pts with CyA TL 200-300ng/ml, and in 38% of cases in pts. with CyA TL over 300 ng/ml. There was no correlation between tacrolimus and MPA level, with TR of MPA achieved in 55% of cases. Considering time after OHT TR of MPA was achieved in 43% of cases during first 3 months after OHT, in 38% of cases during months 4-12 after OHT, and in 56% of cases in patients who completed 1st year after OHT. Conclusion: Many heart transplant recipients receiving MMF do not achieve therapeutic level of MPA, especially with concomitant use of high doses of CyA and in early period after transplantation. 100 SIMVASTATIN TREATMENT IN HEART TRANSPLANT RECIPIENTS DECREASES MYOCARDIAL TUMOR NECROSIS FACTOR ␣ CONTENT S.J. Stetson,1 J.A. Farmer,1 S.C. McRee,1 K.A. Becker,1 M.M. Koerner,1 G.P. Noon,2 G. Torre-Amione,1 1Medicine Cardiology, Baylor College of Medicine, Houston, TX; 2Surgery Transplant Division, Baylor College of Medicine, Houston, TX There are increasing experimental support for the use of statins following cardiac transplantation. Since the clinical benefits observed are not related to their effect on lipids; the effects of statins my be at least partially related to down regulation of
The Journal of Heart and Lung Transplantation Volume 21, Number 1 various immune responses involved in the allograft response. Tumor Necrosis Factor-␣ is a cytokine produced in cardiac allografts and capable of producing hypertrophy and fibrosis. To further define the beneficial effects of statins in heart trasplant recipients, we conducted a prospective randomized controlled study to evaluate the effect of simvastatin on myocardial (m)TNF␣ expression. Ten patients were randomized to receive simvastatiin 20 mg/day (n⫽5) or no therapy (n⫽5), for 6 months following cardiac transplantation. Myocardial TNF␣ and markers of hypertrophy were measured by semi-quantative immunohistochemistry. We found that 1 week post-transplant mTNF content was similar among the simvastatin treated patients and controls (15⫾2.3% tissue area stained vs 15⫾1.5% tissue area stained, respectively, p⫽ns). At 24 weeks post transplant there was a significant reduction in mTNF content in simvastatin treated patients (5.8⫾2.4% tissue area stained, p⫽0.02) whereas there was no change in the controls (12⫾2.6% tissue area stained, p⫽ns). At 24 weeks total collagen content was 21⫾5.7% tissue area stained, in simvastatin treated patients and 25⫾4.7% tissue area stained, in controls (p⫽ns). At 24 weeks myocyte size was 21⫾3.6 microns in simvastatin treated patients and 21⫾0.8 microns in controls. These data indicate that heart transplant recipients treated with simvastatin have lower levels of mTNF that controls. The reduction in mTNF occurred in the absence of a decrease in markers of hypertrophy. We suggest that the beneficial effects of simvastatin in heart transplant recipients may in part be explained by the reduction in mTNF. 101 TRICUSPID VALVE ANNULOPLASTY SIGNIFICANTLY REDUCES EARLY TRICUSPID REGURGITATION AFTER BIATRIAL HEART TRANSPLANTATION A.M. Borkon, N.E. Brown, G.F. Muehlebach, M.E. Gorton, R.S. Stuart, Cardiovascular Surgery, MidAmerica Heart Institute, Kansas City, MO Purpose: Tricuspid Regurgitation (TR) early after cardiac transplant (CTX) may delay recovery, predispose to late right ventricular dysfunction, and ultimately reduce the functional benefit of CTX. The incidence of TR after CTX using biatrial implantation is unpredictable and not infrequently problematic. Although bicaval CTX may reduce the incidence of TR, it can be technically demanding and occasionally associated with caval stenosis. Methods: In an attempt to reduce the incidence of TR observed early after CTX, 25 consecutive patients (PTS) undergoing CTX received donor heart tricuspid annuloplasty (TA). PTS demographics, clinical characteristics, outcomes and early transthoracic echocardiograms were analyzed and compared to an immediately prior and consecutive cohort of 25 PTS undergoing CTX without TA. The biatrial technique of CTX with Cabrol modification was used for donor heart implant in both groups. Echocardiograms were obtained 5 days after CTX and reviewed in blinded fashion. TR was scored 0⫽none, 1⫽mild, 2⫽moderate and 3⫽severe. Results: Donor and recipient characteristics including age, ischemic time, recipient status, and pulmonary vascular resistance were not different between groups. No hospital deaths occurred in either group. CTX without TA had a higher TR score, 1.3 (range 0-3) than CTX with TA, score⫽0.7 (range 0-1.5, P⬍0.05). Moderate or severe TR was present in 8/25 PTS without TA compared to 0/25 PTS with TA (P⬍0.05). Postoperative length of stay was similar for both groups and no PTS required permanent pacemaker.
Abstracts
91
Conclusions: TA can significantly reduce the incidence of early postoperative TR without adding to the complexity of operation. 102 HYPERIMMUNE IVIG MAY BE ADVANTAGEOUS IN COMPARISON TO INTRAVENOUS GANCICLOVIR AS A PREEMPTIVE ANTIVIRAL THERAPY IN CMV-POSITIVE HEART TRANSPLANT RECIPIENTS C.D. Thomas, R. Radovancevic, E.L. Ford, B. Radovancevic, O.H. Frazier, Transplant Service, Texas Heart Institute, Houston, TX Introduction: We compared the effectiveness of preemptive antiviral therapy for prevention of CMV disease using hyperimmune IVIG (Cytogam威; Medimmune) versus intravenous ganciclovir (Cytovene威; Roche Pharmaceuticals) in CMV-positive heart transplant recipients. In a prospective randomized trial, we analyzed data from 18 adult patients who underwent primary heart transplantation from 1997 to 2000. Methods: Peripheral blood leukocytes (PBL) from all 18 patients were assayed by means of CMV pp65 antigenemia assay detected and fluorescent microscopy. The assay, which utilized FITClabeled monoclonal antibodies to CMV lower-matrix protein pp65, was performed weekly for 12 weeks. A positive result was defined as ⬎1 antigen-positive cell per 5x104 PBL. Those patients who received a positive response (Group I, n ⫽ 8 ) received Cytogam威 200 mg/kg IV (Medimmune). The other 10 patients (Group II) received ganciclovir intravenously (IV) 5 mg/kg every 12 hours for 7 days. CMV disease was defined as a positive tissue culture, positive PCR tissue analysis, febrile illness involving a four-fold increase in the CMV IgG level and/or the presence of CMV IgM in the absence rheumatoid factor, or at least two of the following–(1) doubling of SGOT or LDH level, (2) leukopenia (⬍4000 cells/ml), and (3) thrombocytopenia (⬍100,000 cells/ml). Results: The groups were comparable in regard to pretransplant and donor CMV status, immunosuppressive therapy, and incidence of rejections. On average, Group I patients converted to positive antigenemia on day 41 (range, 26-58 days) and Group II patients on day 37.3 (range, 30-43) (p⫽NS). No patients from either group developed CMV disease. The average charge for 1 week of therapy (drug, line placement, and nursing) was $3100 for Group I versus $3600 for Group II. Conclusion: Both arms of this study were effective in preventing development of CMV disease. However, due to its ease of administration and potentially lesser risk of infection from an indwelling line, the Cytogam威 approach appears to be more advantageous. 103 SHRINKAGE OF ALLOGRAFT ARTERIES OCCURS FREQUENTLY AFTER TRANSPLANTATION AND IS ACCOMPANIED WITH PLAQUE SHRINKAGE S.A. Haji, M.H. Yamani, R.C. Starling, P. Schoenhagen, T.D. Crowe, J.B. Young, E.M. Tuzcu, Cardiology, Cleveland Clinic Foundation, Cleveland, OH Background: Both positive and negative arterial remodeling has been described early after transplantation. We sought to determine the relationship between remodeling and the pattern of dynamic plaque changes in the first year after transplantation. Methods: We examined 66 consecutive patients at 1 month and one year after transplantation with serial Intravascular Ultrasound (IVUS), using an automated pullback system (0.5mm/sec).