[Diagnosis, prevention and treatment of cardiac allograft vasculopathy]

Area of Science:

• Cardiovascular Medicine
• Transplantation Immunology
• Pathophysiology

Context:

• Allograft vasculopathy (AV) is a primary limitation to long-term survival following cardiac transplantation.
• This condition, characterized by intimal hyperplasia, affects approximately 30% of heart transplant recipients within five years.
• AV is often clinically silent, posing diagnostic challenges.

Purpose:

• To review current understanding of the pathophysiology, diagnosis, prevention, and treatment of cardiac allograft vasculopathy.
• To highlight emerging diagnostic techniques and areas of ongoing research.
• To incorporate the recent ISHLT nomenclature and guidelines for AV.

Summary:

• Allograft vasculopathy involves concentric and diffuse intimal hyperplasia, a major cause of graft failure post-cardiac transplant.
• Diagnosis relies on coronary angiography with intravascular ultrasound, though non-invasive methods are under development.
• The International Society for Heart and Lung Transplantation (ISHLT) has introduced standardized nomenclature and management guidelines.

Impact:

• Emphasizes the critical need for early diagnosis to prevent disease progression and improve patient prognosis.
• Provides a comprehensive overview for clinicians and researchers managing cardiac transplant patients.
• Informs future research directions in understanding and combating AV.