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Cardiac allograft vasculopathy: real or a normal morphologic variant?

Stuart Houser1, Ashok Muniappan, James Allan

  • 1Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. houser.stuart@mgh.harvard.edu

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|January 30, 2007
PubMed
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Histological similarities between smooth muscle bundles and cardiac allograft vasculopathy (CAV) intimal thickening can misdiagnose graft tolerance. This study clarifies the prevalence of these mimics in porcine and human coronary vasculature.

Area of Science:

  • Cardiology
  • Transplantation Immunology
  • Histopathology

Background:

  • Naive coronary vessels can exhibit intimal thickening, mimicking cardiac allograft vasculopathy (CAV).
  • This histological feature necessitates careful evaluation in transplantation studies.

Purpose of the Study:

  • To appraise the experimental and clinical impact of intimal thickening in naive coronary vessels.
  • To compare the prevalence of CAV mimics in porcine and human coronary vasculature.

Main Methods:

  • Comparative analysis of tissue sections from naive and native porcine hearts, and human hearts.
  • Light microscopy and morphometric analysis were employed.
  • Comparison with experimental models of CAV (rejectors and chimeras) and human CAV cases.

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Last Updated: Jul 17, 2026

Mouse Models for Graft Arteriosclerosis
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Mouse Model of Alloimmune-induced Vascular Rejection and Transplant Arteriosclerosis
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Main Results:

  • Prevalence of CAV mimics in naive/native porcine hearts was low (1.99-2.97%), contrasting with grafts in rejectors (12.4%) but similar to chimeras (2.6%).
  • Human native hearts showed low mimic prevalence (1.95%), while human CAV grafts had higher prevalence (12.80%).
  • Smooth muscle bundles within the internal elastic laminae were similarly prevalent in human and porcine coronary vasculature.

Conclusions:

  • The histological similarity between smooth muscle bundles and CAV intimal thickening can lead to misdiagnosis.
  • Accurate differentiation between graft tolerance and CAV is crucial for both clinical and experimental heart transplantation research.