Related Experiment Videos
Cardiac allograft vasculopathy: current concepts
H O Ventura1, F W Smart, D D Stapleton
1Ochsner Medical Institutions, New Orleans, LA 70121.
Insights
Cardiac allograft vasculopathy, a major cause of late death in heart transplant patients, is a unique intimal hyperplastic process. Retransplantation is the only current definitive therapy, but results are fair.
Area of Science:
- Cardiology
- Transplantation Immunology
Background:
- Cardiac allograft vasculopathy (CAV) is the leading cause of late mortality in heart transplant recipients, affecting 15-20% of patients.
- CAV is distinct from traditional atherosclerosis, characterized by concentric intimal hyperplasia, intact internal elastic lamina, and rare calcification.
Purpose of the Study:
- To describe the characteristics, potential causes, diagnostic methods, and treatment of cardiac allograft vasculopathy.
Main Methods:
- Review of existing literature on cardiac allograft vasculopathy.
- Comparison of diagnostic modalities including coronary angiography, intravascular ultrasound, and coronary angioscopy.
- Evaluation of retransplantation as a therapeutic option.
Main Results:
- CAV typically affects the distal coronary arteries, leading to rapid occlusion.
- Immunologic and non-immunologic endothelial damage may drive the myointimal proliferation seen in CAV.
- Intravascular ultrasound and coronary angioscopy show higher sensitivity for CAV detection than coronary angiography.
Conclusions:
- Cardiac allograft vasculopathy presents unique pathological features compared to atherosclerosis.
- While retransplantation is the only definitive treatment, its success rates are currently limited.
Abstract:
The major cause of late death in cardiac transplant recipients is cardiac allograft vasculopathy also referred to as cardiac transplant atherosclerosis which occurs in 15% to 20% of transplant recipients. It differs from traditional atherosclerosis in that it is a concentric and diffuse intimal hyperplastic process, the internal elastic lamina remains intact, and calcification is rare. The distal portion of the coronary vessel is the earliest to occlude, with occlusion occurring rapidly. Sometimes a low grade vasculitis is also present. There is no definitive reason for cardiac allograft vasculopathy occurring though it has been suggested that it may actually be caused by immunologic and nonimmunologic damage to endothelial cells resulting in myointimal proliferation. Intravascular ultrasound and coronary angioscopy seem to be a more sensitive diagnostic measure of cardiac allograft vasculopathy than coronary angiography. To date, retransplantation seems to be the only definitive therapy for cardiac allograft vasculopathy. But only fair results are being seen with this procedure.