[Graft vascular disease. Its pathogenesis and diagnosis]

Transplant coronary artery disease (EVI) is still the leading cause of late mortality in cardiac transplant patients. The pathogenesis is not determined yet. Probably the basic mechanism is immunological but the subsequent development and progression of the disease depend on the interaction of immunological and nonimmunological factors. Its typical diffuse morphology and its behavior make difficult the diagnosis with non invasive methods. Coronary angiography is not sensitive for an early diagnosis of EVI but its detection has prognostic value. Intracoronary ultrasound (IVUS) is very sensitive to detect angiographically silent lesions, and has correlated well with histological findings. Its prognostic value is still being evaluated. More studies are needed to establish the usefulness of endothelial dysfunction and coronary flow reserve tests in the evaluation of EVI.