C‐reactive protein levels and heart transplant outcome

Background: C‐reactive protein (CRP) levels are associated with development of cardiac allograft vasculopathy (CAV). We studied association between CRP levels and time CAV was first detected, progression of CAV to severity, and need for coronary interventions in heart transplant patients. Methods: We used ELISA to measure CRP levels in sera obtained from 161 patients (median: 7 samples/patient) during first 3 months after heart transplantation; a median CRP value was calculated for each patient. Patients were grouped using AHA criteria as having CRP <1 mg/L, 1–3 mg/L and >3 mg/L. CAV, CAV severity and CAV progression were evaluated with serial annual coronary angiograms (median: 4/patient). Coronary interventions were defined as patients having coronary artery bypass or percutaneous transluminal coronary angioplasty/stent procedures. Results: CRP levels (<1 mg/L, n=40; 1–3 mg/L, n=39; >3 mg/L, n=82) were significantly related to development of CAV (p<0.001), time CAV was first detected (p<0.001), CAV severity (p<0.001) and time to develop severe CAV (p<0.001). A strong association was found between CRP levels and coronary interventions (p=0.017). Conclusions: A significant association was found between early CRP levels and development of CAV; time to develop CAV; CAV severity and progression as well as need for coronary interventions in heart transplant recipients. The data suggest that a proinflammatory environment rich in CRP favors development of CAV in heart transplant patients.