title: Cardiac allograft vasculopathy: diagnosis, therapy, and prognosis.
abstract: Development of cardiac allograft vasculopathy represents the major determinant of long-term survival in patients after heart transplantation. Due to graft denervation, these patients seldom present with classic symptoms of angina pectoris, and the first clinical presentations are progressive heart failure or sudden cardiac death. Although coronary angiography remains the routine technique for coronary artery disease detection, it is not sensitive enough for screening purposes. This is especially the case in the first year after transplantation when diffuse and concentric vascular changes can be easily detected only by intravascular ultrasound. The treatment of the established vasculopathy is disappointing, so the primary effort should be directed toward early prevention and diagnosis. Due to diffuse vascular changes, revascularization procedures are restricted only to a relatively small proportion of patients with favorable coronary anatomy. Percutaneous coronary intervention is preferred over surgical revascularization since it leads to better acute results and patient survival. Although there is no proven long-term advantage of drug-eluting stents for the treatment of in-stent restenosis, they are preferred over bare-metal stents. Severe vasculopathy has a poor prognosis and the only definitive treatment is retransplantation. This article reviews the present knowledge on the pathogenesis, diagnosis, treatment, and prognosis of cardiac allograft vasculopathy.
authors.affiliation: Bosko Skoric, University of Zagreb School of Medicine, Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kispaticeva 12, 10 000 Zagreb, Croatia, bskoric3@yahoo.com.
authors.forename: Boško
authors.initials: B
authors.lastname: Skorić
authors.forename: Maja
authors.initials: M
authors.lastname: Čikeš
authors.forename: Jana
authors.initials: J
authors.lastname: Ljubas Maček
authors.forename: Željko
authors.initials: Ž
authors.lastname: Baričević
authors.forename: Ivan
authors.initials: I
authors.lastname: Škorak
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Gašparović
authors.forename: Bojan
authors.initials: B
authors.lastname: Biočina
authors.forename: Davor
authors.initials: D
authors.lastname: Miličić
mesh_terms: D064591:Allografts; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006085:Graft Survival; D016027:Heart Transplantation; D006801:Humans; D011379:Prognosis