Transplant coronary heart disease: challenges and solutions

• Main Authors: Jentzer JC, Hickey GW, Khandhar SJ
• Format: Article
• Language: English
• Published: Dove Medical Press 2014-12-01
• Series: Transplant Research and Risk Management
• Online Access: http://www.dovepress.com/transplant-coronary-heart-disease-challenges-and-solutions-peer-reviewed-article-TRRM

Jacob C Jentzer,1 Gavin W Hickey,1 Sameer J Khandhar2,3 1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 3Heart and Vascular Institute, Penn-Presbyterian Medical Center, Philadelphia, PA, USAAbstract: Cardiac allograft vasculopathy (CAV) remains one of the leading causes of death and graft failure after heart transplantation. A variety of causes, including donor heart characteristics, recipient risk factors, and immune-mediated influences, are associated with developing CAV. In this review, we will focus on the pathophysiology of developing CAV and various methods to screen for this condition. The pathogenesis of CAV likely involves repeated injuries to the endothelium from a variety of factors such as cellular-mediated rejection, and alloimmune factors, including antibody-mediated injury, ischemia-reperfusion injury at time of transplant, cytomegalovirus infections, immunosuppression medications, systemic inflammation, and traditional atherosclerosis risk factors. Patients with significant CAV are often asymptomatic, and therefore early detection by routine screening prior to graft dysfunction is crucial. There are a variety of invasive, noninvasive, and blood tests that have been studied as screening methods, and we will discuss the role of each of these in this review article. Although some treatment regimens have been established for CAV, this is an area where further studies and research are necessary.Keywords: cardiac allograft vasculopathy, orthotopic heart transplantation, intra-vascular imaging