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Prevention and treatment of cardiac allograft vasculopathy

Howard J Eisen, MD
Section Editor
Sharon A Hunt, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Cardiac transplantation is the definitive therapy for eligible patients with end-stage heart failure. The major limitations to survival in the early (first one year) post-transplant period are nonspecific graft failure, multiorgan failure, acute rejection, and infection [1,2]. Beyond the first year, cardiac allograft vasculopathy (CAV, also called transplant coronary artery disease or cardiac transplant vasculopathy) is among the top three causes of death, after malignancy as shown in the reports of the Registry of the International Society of Heart and Lung Transplantation [1]. (See "Prognosis after cardiac transplantation", section on 'Causes of death'.)

The approach to the prevention and treatment of CAV will be reviewed here. The pathogenesis of allograft vasculopathy is discussed separately. (See "Pathogenesis of and risk factors for cardiac allograft vasculopathy".)


The natural history and diagnosis of allograft vasculopathy are discussed separately, but the major findings will be reviewed here. (See "Diagnosis and prognosis of cardiac allograft vasculopathy".)

Summarized briefly:

The heart is denervated at the time of transplant and reinnervation is generally incomplete. As a result, vasculopathy generally progresses silently and, in some cases, rapidly. Because of afferent denervation, affected patients seldom present with classic symptoms of angina. Silent myocardial infarction, sudden death, and progressive heart failure are common presentations. Symptoms associated with exertion, such as dyspnea, diaphoresis, gastrointestinal distress, presyncope, or syncope, are often infrequent, atypical, and may be misleading.

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Literature review current through: Nov 2017. | This topic last updated: Oct 05, 2017.
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