Cardiac allograft vasculopathy: current concepts.

The major cause of late death in cardiac transplant recipients is cardiac allograft vasculopathy also referred to as cardiac transplant atherosclerosis which occurs in 15% to 20% of transplant recipients. It differs from traditional atherosclerosis in that it is a concentric and diffuse intimal hyperplastic process, the internal elastic lamina remains intact, and calcification is rare. The distal portion of the coronary vessel is the earliest to occlude, with occlusion occurring rapidly. Sometimes a low grade vasculitis is also present. There is no definitive reason for cardiac allograft vasculopathy occurring though it has been suggested that it may actually be caused by immunologic and nonimmunologic damage to endothelial cells resulting in myointimal proliferation. Intravascular ultrasound and coronary angioscopy seem to be a more sensitive diagnostic measure of cardiac allograft vasculopathy than coronary angiography. To date, retransplantation seems to be the only definitive therapy for cardiac allograft vasculopathy. But only fair results are being seen with this procedure.