title: Cardiac allograft vasculopathy.
abstract: Cardiac allograft vasculopathy (CAV) is the most important cause of morbidity and         mortality following cardiac transplantation. CAV is largely mediated by immunologic         damage and infiltration of the endothelium, resulting in proliferation of vascular         smooth muscle cells and subsequent luminal narrowing. There are various risk factors         for the development and progression of CAV. Coronary angiography is the gold         standard for the diagnosis of CAV; intravascular ultrasound also plays an important         role. The management of CAV includes immunosuppression, drugs that modify         conventional coronary artery disease risk factors, and percutaneous coronary intervention         (PCI) or surgical revascularization for severe obstructive lesions. Although revascularization         with PCI has a high immediate success rate, rates of in-stent restenosis are         higher as compared with PCI of native coronary arteries, although the advent of         drug-eluting stents has somewhat improved in-stent restenosis rates. Thus, the only         definitive treatment of CAV is repeat transplantation. Randomized trials are needed         to determine the optimal immunosuppressive and conventional risk factor-modifying         agents and revascularization strategies for patients who develop CAV.
authors.affiliation: University of California, Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Will
authors.initials: W
authors.lastname: Finch
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents