Pietra Biagio, Boucek Mark
Department of Pediatrics, The Children's Hospital, Denver, Colorado 80212, USA.
Paediatr Drugs. 2003;5(8):513-24. doi: 10.2165/00148581-200305080-00002.
The single largest cause of late graft loss in pediatric cardiac transplantation is transplant coronary artery vasculopathy (CAV). The mechanism of CAV remains unknown; it appears to have both immune and non-immune causes. The final common pathway of these mechanisms is endothelial activation, a prothrombotic environment, and endothelial damage with subsequent diffuse intimal proliferation. The disease process has largely been thought to be progressive and unresponsive to treatment. Re-transplantation has been advocated as the only definitive treatment. The appropriate management is largely unknown; intervention or surgical management has had limited utility, while medical management appears to have the most promise. Improvement in outcome can be achieved by optimizing non-immune factors and aggressive management of the immune mechanisms. Long-term survival of transplant patients after diagnosis with CAV is now being reported.
小儿心脏移植术后晚期移植物丢失的单一最大原因是移植冠状动脉血管病变（CAV）。CAV的发病机制尚不清楚；它似乎有免疫和非免疫两种原因。这些机制的最终共同途径是内皮激活、促血栓形成环境以及内皮损伤伴随后的弥漫性内膜增生。该疾病过程在很大程度上被认为是进行性的且对治疗无反应。再次移植一直被倡导为唯一的确定性治疗方法。合适的管理方法在很大程度上尚不清楚；干预或手术管理的效用有限，而药物管理似乎最有前景。通过优化非免疫因素和积极管理免疫机制可以实现预后改善。目前已有关于CAV诊断后移植患者长期生存的报道。
