Manoushagian S, Meshkov A
Department of Internal Medicine, Temple University Hospital, Philadelphia, PA.
Am J Transplant. 2014 Oct;14(10):2228-34. doi: 10.1111/ajt.12915. Epub 2014 Sep 12.
Solid organ transplantation has increased in frequency in the United States, having evolved from an area of experimentation into accepted therapy for end-organ failure. As organ transplantation has become more common, the average age of transplant recipients has increased, thus increasing the potential for multiple comorbidities including coronary artery disease (CAD). CAD has been shown to be a major cause of morbidity and mortality in kidney, lung and liver transplant recipients. Identification of CAD in solid organ transplant candidates allows for stratification of short- and long-term risk, ensuring proper use of valuable allograft resources while guiding further patient management. Assessment of asymptomatic transplant candidates for CAD is difficult. Many patients undergo stress echocardiography or nuclear imaging, which have demonstrated inconsistent rates of sensitivity and specificity for the detection of CAD in these patient populations. Cardiac computed tomography is a potential tool for detecting CAD in these populations, but has questionable utility at this time. Coronary angiography has an important role in detecting CAD in high-risk transplant candidates, affecting their long-term management and risk.
在美国，实体器官移植的频率有所增加，它已从一个实验领域发展成为终末期器官衰竭的公认治疗方法。随着器官移植变得越来越普遍，移植受者的平均年龄有所增加，从而增加了包括冠状动脉疾病（CAD）在内的多种合并症的可能性。CAD已被证明是肾、肺和肝移植受者发病和死亡的主要原因。在实体器官移植候选者中识别CAD有助于对短期和长期风险进行分层，确保宝贵的同种异体移植资源得到合理利用，同时指导进一步的患者管理。对无症状的移植候选者进行CAD评估很困难。许多患者接受负荷超声心动图或核成像检查，这些检查在检测这些患者群体中的CAD时，敏感性和特异性的比率并不一致。心脏计算机断层扫描是检测这些人群中CAD的一种潜在工具，但目前其效用存在疑问。冠状动脉造影在检测高危移植候选者的CAD方面具有重要作用，会影响他们的长期管理和风险。
