Cardiac Allograft Vasculopathy: What We Know in 2016

被引：0
作者：
Gilotra N.A. [1 ]
Okwuosa I.S. [1 ]
Russell S.D. [1 ,2 ]
机构：
[1] Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
[2] Division of Cardiology, Johns Hopkins Hospital, Sheikh Zayed Tower Suite 7125, 1800 Orleans St., Baltimore, 21287, MD
来源：
Current Transplantation Reports | 2016年 / 3卷 / 3期
关键词：
Allograft vasculopathy; Coronary artery disease; Heart transplantation; IVUS; Rejection; Retransplantation;
D O I：
10.1007/s40472-016-0105-x
中图分类号：
学科分类号：
摘要：
Cardiac allograft vasculopathy (CAV) is an immune and nonimmune-mediated process in which heart transplantation patients develop neointimal proliferative hyperplasia of the coronary arteries, typically starting distally and resulting in diffuse luminal narrowing. Risk factors include traditional coronary risk factors often resulting from side effects of immunosuppressive drugs, infection by cytomegalovirus and rejection, particularly antibody-mediated. Despite the advent of effective immunosuppression, CAV remains the primary cause of long-term mortality for heart transplant recipients. Patients undergo routine protocol surveillance for CAV after transplant, and various noninvasive and invasive diagnostic approaches can be employed in suspected CAV. Therapy is aimed primarily at prevention, given the incurable nature of CAV. The mainstay preventive therapies include statins and anti-proliferative immunosuppressive agents. In patients who develop CAV, treatment includes percutaneous coronary intervention and even retransplantation as CAV can result in irreversible systolic dysfunction and/or restrictive cardiomyopathy. This critical review aims to summarize our current knowledge of risk factors, diagnostic strategies, and therapy for CAV in heart transplant patients. © 2016, Springer International Publishing AG.
引用
收藏
页码：175 / 184
页数：9
相关论文
共 89 条
  • [1] Wilhelm M.J., Long-term outcome following heart transplantation: current perspective, J Thorac Dis, 7, 3, (2015)
  • [2] Lund L.H., Edwards L.B., Kucheryavaya A.Y., Et al., The Registry of the International Society for Heart and Lung Transplantation: Thirty-first Official Adult Heart Transplant Report—2014
  • [3] focus theme: Retransplantation, J Heart Lung Transplant, 33, 10, pp. 996-1008, (2014)
  • [4] Cooper D.K., Christiaan Barnard and his contributions to heart transplantation, J Heart Lung Transplant, 20, 6, pp. 599-610, (2001)
  • [5] Brink J.G., Hassoulas J., The first human heart transplant and further advances in cardiac transplantation at Groote Schuur hospital and the university of cape town—with reference to: the operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur hospital, Cape Town, Cardiovasc J Afr, 20, 1, pp. 31-35, (2009)
  • [6] Hunt S.A., Haddad F., The changing face of heart transplantation, J Am Coll Cardiol, 52, 8, pp. 587-598, (2008)
  • [7] Schmauss D., Weis M., Cardiac allograft vasculopathy: recent developments, Circulation, 117, 16, pp. 2131-2141, (2008)
  • [8] Ramzy D., Rao V., Brahm J., Miriuka S., Cardiac allograft vasculopathy: a review, Can J Surg, 48, 4, (2005)
  • [9] Aranda J.M., Hill J., Cardiac transplant vasculopathy, CHEST J, 118, 6, pp. 1792-1800, (2000)
  • [10] Segovia J., Update on cardiac allograft vasculopathy, Curr Opin Organ Transplant, 7, 3, pp. 240-251, (2002)
123456789