Cardiac allograft vasculopathy in the elderly heart transplant recipient

Advances in immunosuppression have improved the early survival of heart transplant recipients, but cardiac allograft vasculopathy (accelerated graft atherosclerosis) is the leading cause of graft loss after the first year of transplantation. In this review we discuss recent developments in our understanding of cardiac allograft vasculopathy, with particular reference to the elderly heart transplant recipient. As both donor age and recipient age are potential risk factors in heart transplantation, it is only prudent to examine their disparate impact on development of this disease process. Available observational studies using angiography and ultrasound for the clinical detection of cardiac allograft vasculopathy suggest that older age does not predispose to the development of this disease. However, recipients of older allografts might be at increased risk of development of prognostically relevant allograft intimal proliferation. This group of heart transplant recipients may need closer monitoring and more aggressive risk-factor modification.