title: The challenge of allograft vasculopathy in cardiac transplantation.
abstract: OBJECTIVE
  Cardiac allograft vasculopathy (CAV) is a unique form of accelerated atherosclerosis occurring in heart transplant recipients and this complication has a major negative impact on long-term survival. An understanding of recent advances in the understanding of CAV pathogenesis, accurate diagnosis and effective treatment is important given the increasing number of heart transplant procedures being performed annually.
  
  
  RESULTS
  This review article will discuss the complex immunological and nonimmunological processes that are likely to contribute to endothelial activation and the chronic inflammatory response causing intimal hyperplasia that is characteristic of CAV. Accurate diagnosis of CAV is essential, and both current and emerging imaging modalities will be reviewed. Finally, current treatment of CAV, together with future therapeutic strategies, will be discussed.
  
  
  CONCLUSIONS
  CAV is an important complication-limiting survival after heart transplant, and a clear understanding of the underlying pathophysiological processes is important. The diagnosis of CAV can be difficult, but it is possible with the appropriate imaging modalities. Effective treatment of CAV remains an important clinical challenge, and current immunosuppressive therapy has limited efficacy. However, newer immunosuppressive agents have demonstrated promising results in clinical trials, and this will hopefully allow more effective disease management in the near future.
authors.affiliation: aDepartment of Cardiology, Oslo University Hospital Rikshospitalet bKG. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Satish
authors.initials: S
authors.lastname: Arora
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
mesh_terms: D000818:Animals; D016027:Heart Transplantation; D006801:Humans; D007155:Immunologic Factors / Q000276:immunology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents