Elevated Uric Acid Levels Predict Allograft Vasculopathy in Cardiac Transplant Recipients

Michelle M. Kittleson, Valeriani Bead, Michael Fradley, Marcus E. St. John, Hunter C. Champion, Edward K. Kasper, Stuart D. Russell, Ilan S. Wittstein, Joshua Hare

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Cardiac allograft vasculopathy (CAV) poses the greatest threat to the long-term survival of cardiac transplant recipients, and these individuals often exhibit elevated levels of uric acid (UA), a stimulator of T cells. We hypothesized that hyperuricemia is associated with CAV in cardiac transplant recipients. Methods: UA levels were measured in cardiac transplant recipients between January 2003 and January 2005. Surveillance cardiac catheterizations performed 3 months to 1 year after UA measurement were reviewed. The relationship between UA and CAV was adjusted for possible confounders with propensity scores and confirmed with goodness-of-fit tests. Results: The 105 patients included in this study were a median 63.3 months post-transplant and their left heart catheterizations were performed a median 5.6 months after UA measurement. Focal stenosis was evident in 25 angiograms and 31 showed distal pruning of the coronary arteries. Compared with the lowest quartile of UA, the highest quartile had an increased risk of CAV: odds ratio (OR) 6.11 (95% CI 1.47 to 25.5; p = 0.013) for focal stenosis and OR 4.60 (95% CI 1.34 to 15.8; p = 0.015) for distal pruning. After adjustment, this relationship persisted for both focal stenosis (OR 5.53, 95% confidence interval [CI] 1.29 to 23.7; p = 0.021) and distal pruning (OR 4.21, 95% CI 1.15 to 15.4; p = 0.029). Conclusions: Elevated UA confers an increased risk of CAV. This association may be causal, with pathophysiologic implications for the role of hyperuricemia in allograft failure and, if substantiated, could have clinical implications for the use of xanthine oxidase inhibitors in cardiac transplant recipients.

Original languageEnglish
Pages (from-to)498-503
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume26
Issue number5
DOIs
StatePublished - May 1 2007

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Uric Acid
Allografts
Odds Ratio
Confidence Intervals
Hyperuricemia
Pathologic Constriction
Cardiac Catheterization
Propensity Score
Xanthine Oxidase
Transplant Recipients
Coronary Vessels
Angiography
T-Lymphocytes
Transplants
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Elevated Uric Acid Levels Predict Allograft Vasculopathy in Cardiac Transplant Recipients. / Kittleson, Michelle M.; Bead, Valeriani; Fradley, Michael; St. John, Marcus E.; Champion, Hunter C.; Kasper, Edward K.; Russell, Stuart D.; Wittstein, Ilan S.; Hare, Joshua.

In: Journal of Heart and Lung Transplantation, Vol. 26, No. 5, 01.05.2007, p. 498-503.

Research output: Contribution to journalArticle

Kittleson, MM, Bead, V, Fradley, M, St. John, ME, Champion, HC, Kasper, EK, Russell, SD, Wittstein, IS & Hare, J 2007, 'Elevated Uric Acid Levels Predict Allograft Vasculopathy in Cardiac Transplant Recipients', Journal of Heart and Lung Transplantation, vol. 26, no. 5, pp. 498-503. https://doi.org/10.1016/j.healun.2007.01.039
Kittleson, Michelle M. ; Bead, Valeriani ; Fradley, Michael ; St. John, Marcus E. ; Champion, Hunter C. ; Kasper, Edward K. ; Russell, Stuart D. ; Wittstein, Ilan S. ; Hare, Joshua. / Elevated Uric Acid Levels Predict Allograft Vasculopathy in Cardiac Transplant Recipients. In: Journal of Heart and Lung Transplantation. 2007 ; Vol. 26, No. 5. pp. 498-503.
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abstract = "Background: Cardiac allograft vasculopathy (CAV) poses the greatest threat to the long-term survival of cardiac transplant recipients, and these individuals often exhibit elevated levels of uric acid (UA), a stimulator of T cells. We hypothesized that hyperuricemia is associated with CAV in cardiac transplant recipients. Methods: UA levels were measured in cardiac transplant recipients between January 2003 and January 2005. Surveillance cardiac catheterizations performed 3 months to 1 year after UA measurement were reviewed. The relationship between UA and CAV was adjusted for possible confounders with propensity scores and confirmed with goodness-of-fit tests. Results: The 105 patients included in this study were a median 63.3 months post-transplant and their left heart catheterizations were performed a median 5.6 months after UA measurement. Focal stenosis was evident in 25 angiograms and 31 showed distal pruning of the coronary arteries. Compared with the lowest quartile of UA, the highest quartile had an increased risk of CAV: odds ratio (OR) 6.11 (95{\%} CI 1.47 to 25.5; p = 0.013) for focal stenosis and OR 4.60 (95{\%} CI 1.34 to 15.8; p = 0.015) for distal pruning. After adjustment, this relationship persisted for both focal stenosis (OR 5.53, 95{\%} confidence interval [CI] 1.29 to 23.7; p = 0.021) and distal pruning (OR 4.21, 95{\%} CI 1.15 to 15.4; p = 0.029). Conclusions: Elevated UA confers an increased risk of CAV. This association may be causal, with pathophysiologic implications for the role of hyperuricemia in allograft failure and, if substantiated, could have clinical implications for the use of xanthine oxidase inhibitors in cardiac transplant recipients.",
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T1 - Elevated Uric Acid Levels Predict Allograft Vasculopathy in Cardiac Transplant Recipients

AU - Kittleson, Michelle M.

AU - Bead, Valeriani

AU - Fradley, Michael

AU - St. John, Marcus E.

AU - Champion, Hunter C.

AU - Kasper, Edward K.

AU - Russell, Stuart D.

AU - Wittstein, Ilan S.

AU - Hare, Joshua

PY - 2007/5/1

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N2 - Background: Cardiac allograft vasculopathy (CAV) poses the greatest threat to the long-term survival of cardiac transplant recipients, and these individuals often exhibit elevated levels of uric acid (UA), a stimulator of T cells. We hypothesized that hyperuricemia is associated with CAV in cardiac transplant recipients. Methods: UA levels were measured in cardiac transplant recipients between January 2003 and January 2005. Surveillance cardiac catheterizations performed 3 months to 1 year after UA measurement were reviewed. The relationship between UA and CAV was adjusted for possible confounders with propensity scores and confirmed with goodness-of-fit tests. Results: The 105 patients included in this study were a median 63.3 months post-transplant and their left heart catheterizations were performed a median 5.6 months after UA measurement. Focal stenosis was evident in 25 angiograms and 31 showed distal pruning of the coronary arteries. Compared with the lowest quartile of UA, the highest quartile had an increased risk of CAV: odds ratio (OR) 6.11 (95% CI 1.47 to 25.5; p = 0.013) for focal stenosis and OR 4.60 (95% CI 1.34 to 15.8; p = 0.015) for distal pruning. After adjustment, this relationship persisted for both focal stenosis (OR 5.53, 95% confidence interval [CI] 1.29 to 23.7; p = 0.021) and distal pruning (OR 4.21, 95% CI 1.15 to 15.4; p = 0.029). Conclusions: Elevated UA confers an increased risk of CAV. This association may be causal, with pathophysiologic implications for the role of hyperuricemia in allograft failure and, if substantiated, could have clinical implications for the use of xanthine oxidase inhibitors in cardiac transplant recipients.

AB - Background: Cardiac allograft vasculopathy (CAV) poses the greatest threat to the long-term survival of cardiac transplant recipients, and these individuals often exhibit elevated levels of uric acid (UA), a stimulator of T cells. We hypothesized that hyperuricemia is associated with CAV in cardiac transplant recipients. Methods: UA levels were measured in cardiac transplant recipients between January 2003 and January 2005. Surveillance cardiac catheterizations performed 3 months to 1 year after UA measurement were reviewed. The relationship between UA and CAV was adjusted for possible confounders with propensity scores and confirmed with goodness-of-fit tests. Results: The 105 patients included in this study were a median 63.3 months post-transplant and their left heart catheterizations were performed a median 5.6 months after UA measurement. Focal stenosis was evident in 25 angiograms and 31 showed distal pruning of the coronary arteries. Compared with the lowest quartile of UA, the highest quartile had an increased risk of CAV: odds ratio (OR) 6.11 (95% CI 1.47 to 25.5; p = 0.013) for focal stenosis and OR 4.60 (95% CI 1.34 to 15.8; p = 0.015) for distal pruning. After adjustment, this relationship persisted for both focal stenosis (OR 5.53, 95% confidence interval [CI] 1.29 to 23.7; p = 0.021) and distal pruning (OR 4.21, 95% CI 1.15 to 15.4; p = 0.029). Conclusions: Elevated UA confers an increased risk of CAV. This association may be causal, with pathophysiologic implications for the role of hyperuricemia in allograft failure and, if substantiated, could have clinical implications for the use of xanthine oxidase inhibitors in cardiac transplant recipients.

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