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Coronary artery disease in heart transplantation: new concepts for an old disease

Mandy Langstraat1, Kyra J S Musters1, Olivier Manintveld2

  • 1School of Medicine, Erasmus MC, Rotterdam, The Netherlands.

Transplant International : Official Journal of the European Society for Organ Transplantation
|February 18, 2018
PubMed

Insights

Cardiac allograft vasculopathy (CAV) is a major long-term risk after heart transplants. Recent evidence highlights varying pathology and emphasizes prevention through risk factor control and targeted immunosuppression over treatment.

Area of Science:

  • Cardiology
  • Transplantation Immunology
  • Medical Research

Background:

  • Cardiac allograft vasculopathy (CAV) is a primary long-term complication following heart transplantation.
  • Understanding evolving risk factors, pathology, and therapeutic strategies for CAV is crucial for improving patient outcomes.

Purpose of the Study:

  • To systematically review recent (6-year) literature on cardiac allograft vasculopathy (CAV).
  • To reappraise novel evidence regarding risk factors, pathology, prevention, and treatment of CAV.

Main Methods:

  • Conducted a systematic literature search on PubMed using a defined search string.
  • Included 98 studies focusing on CAV risk factors, pathology, prevention, and treatment.
  • Excluded studies focused solely on diagnosis, biomarkers, imaging, or other disease complications.

Main Results:

  • Identified 48 articles on CAV risk factors, 13 on pathology, 24 on prevention, and 13 on treatment.
  • Found evidence that CAV pathophysiology may differ based on time post-transplant and the balance of metabolic versus immune factors.
  • Selective revascularization of focal lesions showed some clinical benefit.

Conclusions:

  • CAV prevention, by managing risk factors and employing targeted immunosuppression, is the most evidence-based strategy.
  • This approach is superior to treatment for reducing disease progression.
  • Pathophysiological understanding of CAV continues to evolve, influenced by transplant duration and risk factor profiles.

Keywords:
cardiac allograft vasculopathygraft dysfunctionheart transplantationpathologyrisk factors

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