Cardiac Allograft Vasculopathy

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Abstract

The major cause of late death in cardiac transplant recipients is cardiac allograft vasculopathy, also referred to as cardiac transplant atheroesclerosis, which occurs in 15% to 20% of transplant recipients. It differs from traditional atheroesclerosis in that it is a concentric and diffuse intimal hyper-plastic process, the internal elastic lamina remains intact, and calcification is rare. The distal portion of the coronary vessel occludes early, and it does so rapidly. Sometimes a low grade vasculitis is also present. There is no definitive reason for cardiac allograft vasculopathy, though it has been suggested that it may actually be caused by immunologic and non immunologic damage to endothelial cells resulting in myointimal proliferation. Intra-vascular ultrasound and coronary angioscopy seem to be more sensitive diagnostic measures for cardiac allograft vasculopathy than coronary angiography. Up to date, retransplantation is considered to be the only definitive therapy for cardiac allograft vasculopathy, but with only fair results.