title: Coronary cardiac allograft vasculopathy versus native atherosclerosis: difficulties in classification.
abstract: Cardiac allograft vasculopathy is regarded as a progressive and diffuse intimal hyperplastic lesion of arteries and veins that leads to insidious vessel narrowing and to allograft ischemic disease, such as acute myocardial infarction or sudden cardiac death. The coronary lesions in transplanted hearts are considered as a particular type of arteriosclerosis with many similarities but also significant differences compared to native coronary atherosclerosis. It is particularly difficult for pathologists to systematically classify the lesions and to elucidate their origins, since over time, the allograft immune responses cause vascular pathology characterized by not only the onset of de novo fibrocellular lesions but also remodeling of already-existing native atherosclerotic lesions in the donor heart. Intraplaque hemorrhages, which result from newly formed leaky microvessels, may cause rapid increase of stenosis and generate a substrate for plaque destabilization. Comparing cardiac allograft vasculopathy from explanted hearts at autopsy with native coronary atherosclerosis from hearts removed at transplantation has revealed that ongoing intraplaque hemorrhages are also an important feature of cardiac allograft vasculopathy and may be important factors in the rapid progression of cardiac allograft vasculopathy.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Gabelli, 61, 35100, Padua, Italy, annalisa.angelini@unipd.it.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Angelini
authors.forename: Chiara
authors.initials: C
authors.lastname: Castellani
authors.forename: Marny
authors.initials: M
authors.lastname: Fedrigo
authors.forename: Onno J
authors.initials: OJ
authors.lastname: de Boer
authors.forename: Lorine B
authors.initials: LB
authors.lastname: Meijer-Jorna
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Li
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Valente
authors.forename: Gaetano
authors.initials: G
authors.lastname: Thiene
authors.forename: Allard C
authors.initials: AC
authors.lastname: van der Wal
mesh_terms: D003324:Coronary Artery Disease / Q000473:pathology*; D006084:Graft Rejection / Q000473:pathology*; D006331:Heart Diseases / Q000145:classification* / Q000473:pathology*; D016027:Heart Transplantation; D006801:Humans