Coronary artery vasculopathy in pediatric cardiac transplant patients: the therapeutic potential of immunomodulators.
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.
Pietra
Biagio
B
Department of Pediatrics, The Children's Hospital, Denver, Colorado 80212, USA. bill.peitra@uchsc.edu
Boucek
Mark
M
D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology / Q000601:surgery; D004730:Endothelium, Vascular / Q000473:pathology; D015316:Genetic Therapy; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents