Dhaliwal Amandeep, Thohan Vinay
Methodist DeBakey Heart Center, Houston, TX 77030, USA.
Curr Atheroscler Rep. 2006 Mar;8(2):119-30. doi: 10.1007/s11883-006-0049-1.
Over the past 40 years, cardiac transplantation has evolved as the single best long-term option for eligible candidates with end-stage heart failure. Approximately 2000 transplants are performed annually in the United States, and with the institution of calcineurin-based immunotherapy, surveillance biopsies, and programmatic-based patient care, life expectancy at 1 and 12 years is 85% and 50%, respectively. Cardiac allograft vasculopathy (CAV) is the number one cause of death after the first year of transplantation. The incidence of CAV remains as high as 50% at 5 years, with life expectancy significantly abbreviated once it is recognized. Although current immunotherapy has reduced the likelihood of cellular rejection, it has not impacted CAV substantially. Better treatment of established risk factors and the advent of newer antiproliferative immunotherapy may hold promise in treating CAV. However, future therapies must address the multitude of mechanisms underlying CAV. This manuscript reviews the pathophysiology, clinical manifestations, screening, and diagnostic strategies for cardiac allograft vasculopathy while emphasizing current treatment paradigms designed to stave off or retard the progression of CAV.
在过去40年里，心脏移植已发展成为终末期心力衰竭合格患者的最佳长期单一选择。在美国，每年大约进行2000例心脏移植手术。随着基于钙调神经磷酸酶的免疫疗法、监测活检以及基于项目的患者护理的实施，1年和12年的预期寿命分别为85%和50%。心脏移植血管病变（CAV）是移植后第一年死亡的首要原因。CAV在5年时的发病率仍高达50%，一旦被发现，预期寿命会显著缩短。尽管目前的免疫疗法降低了细胞排斥的可能性，但对CAV的影响不大。更好地治疗已确定的危险因素以及新型抗增殖免疫疗法的出现可能为治疗CAV带来希望。然而，未来的治疗方法必须解决CAV背后的多种机制。本文综述了心脏移植血管病变的病理生理学、临床表现、筛查和诊断策略，同时强调了旨在延缓或阻止CAV进展的当前治疗模式。
