Related Experiment Video
Updated: Aug 16, 2026
Murine Cervical Aortic Transplantation Model using a Modified Non-Suture Cuff Technique
Published on: November 2, 2019
Cardiac allograft vasculopathy: a review
Danny Ramzy1, Vivek Rao, Julie Brahm
1Heart Transplant Program, Toronto General Hospital, University Health Network, Division of Cardiac Surgery, University of Toronto, Toronto, ON.
Insights
Cardiac allograft vasculopathy (CAV) is a serious complication after heart transplants. Preventing CAV by managing risk factors is crucial due to limited treatment options and poor outcomes.
Area of Science:
- Cardiology
- Transplantation Immunology
Background:
- Cardiac allograft vasculopathy (CAV) significantly limits long-term survival post-cardiac transplantation.
- CAV is an accelerated form of coronary artery disease (CAD) involving intimal hyperplasia in coronary vessels.
- Both immunologic and non-immunologic factors contribute to endothelial dysfunction, injury, and intimal thickening in CAV.
Purpose of the Study:
- To review the occurrence, pathophysiology, diagnosis, and treatment of CAV.
- To highlight current research areas for CAV prevention and management.
- To emphasize the importance of mitigating risk factors for improved transplant outcomes.
Main Methods:
- Review of existing literature on cardiac allograft vasculopathy.
- Analysis of diagnostic challenges, including limitations of angiography and intravascular ultrasonography.
- Discussion of therapeutic strategies and preventative measures.
Main Results:
- CAV diagnosis is challenging due to limitations in current imaging modalities.
- Effective treatments for established CAV are limited, often necessitating re-transplantation.
- Prevention strategies targeting endothelial injury are critical.
Conclusions:
- Mitigating immunologic and non-immunologic risk factors is paramount for CAV prevention.
- Therapeutic interventions before, during, and after transplantation may protect against endothelial injury.
- Further research into CAV pathophysiology and prevention is essential for improving cardiac allograft survival.
Abstract:
Cardiac allograft vasculopathy (CAV) is a major factor limiting long-term survival after cardiac transplantation. CAV is an accelerated form of coronary artery disease (CAD) that is characterized by concentric fibrous intimal hyperplasia along the length of coronary vessels. Both immunologic and nonimmunologic risk factors contribute to the development of CAV by causing endothelial dysfunction and injury eventually leading to progressive intimal thickening. The diagnosis of CAV remains a challenge as angiography, the standard method for detecting focal plaques, lacks sensitivity in detecting CAV, and intravascular ultrasonography, a more sensitive method, lacks the ability to evaluate the entire coronary tree. The disease is difficult to treat and results in significant morbidity and mortality. Since treatment of CAV is limited and usually involves repeat transplantation, prevention or mitigation of immunologic and nonimmunologic risk factors is critically important. CAV prevention may involve therapy that provides protection against endothelial injury implemented just before transplantation, during storage and transplantation as well as after transplantation. This review addresses the frequency of occurrence, pathophysiology, diagnosis and treatment of CAV, highlighting areas of active research.
