title: Assessment of cardiac allograft vasculopathy in cardiac transplantation: experience of a Brazilian center.
abstract: BACKGROUND
  Cardiac transplantation continues to be the treatment of choice for heart failure refractory to optimized treatment. Two methods have high sensitivity for diagnosing allograft rejection episodes and cardiac allograft vasculopathy (CAV), important causes of mortality after transplantation.
  
  
  OBJECTIVE
  To assess the relationship between intravascular ultrasound (IVUS) results and endomyocardial biopsy (BX) reports in the follow-up of patients undergoing cardiac transplantation in a Brazilian reference service.
  
  
  METHODS
  A retrospective epidemiological observational study was carried out with patients undergoing orthotopic cardiac transplantation from 2000 to 2009. The study assessed the medical records of those patients and the results of the IVUS and BX routinely performed in the clinical post-transplant follow-up, as well as the therapy used.
  
  
  RESULTS
  Of the 77 patients assessed, 63.63% were males, their ages ranging from 22 to 69 years. Regarding the IVUS results, 33.96% of the patients were classified as Stanford class I, and 32.08%, as Stanford class IV. Of the 143 BX reports, 51.08% were 1R, and 0.69%, 3R. The Quilty effect was described in 14.48% of the BX reports. All patients used antiproliferative agents, 80.51% used calcineurin inhibitors, and 19.48% used proliferation signal inhibitors.
  
  
  CONCLUSIONS
  The assessment of cardiac transplant patients by use of IVUS provides detailed information for the early and sensitive diagnosis of CAV, which is complemented by histological data derived from BX, establishing a possible causal relationship between CAV and humoral rejection episodes.
authors.affiliation: Irmandade da Santa Casa de Misericórdia de Curitiba. elide@cardiol.br
authors.forename: Elide Sbardellotto Mariano da
authors.initials: ES
authors.lastname: Costa
authors.forename: Ricardo
authors.initials: R
authors.lastname: Wang
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Susin
authors.forename: Sergio Lopes
authors.initials: SL
authors.lastname: Veiga
authors.forename: Francisco Costa
authors.initials: FC
authors.lastname: Diniz
authors.forename: Paulo Roberto Slud
authors.initials: PR
authors.lastname: Brofman
authors.forename: Lidia Ana Zytynski
authors.initials: LA
authors.lastname: Moura
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001706:Biopsy; D001938:Brazil; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000473:pathology*; D016027:Heart Transplantation / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D014184:Transplantation, Homologous / Q000473:pathology; D014463:Ultrasonography; D055815:Young Adult