Arterial hypertension after orthotopic cardiac transplantation

Fröhlich, Edward D.; Ventura, Héctor O.; Ochsner, John L.

doi:10.1016/0735-1097(90)90248-n

Cited by 13 publications

(13 citation statements)

References 11 publications

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“…Post-transplant hypertension plays a significant role in the onset of angiographic CAV. Hypertension in cardiac transplant recipients is multifactorial and various mechanisms are implicated in the genesis of hypertension [102][103][104][105][106][107]. The pathogenesis of hypertension in heart transplant recipients is multifactorial and complex.…”

Section: Hypertensionmentioning

confidence: 99%

“…The pathogenesis of hypertension in heart transplant recipients is multifactorial and complex. The denervated status of cardiac allograft results in impaired regulation of Renin-Angiotensin-Aldosterone System (RAAS) [102]. Corticosteroids and CNIs are the cornerstone of immunosuppressive therapy in heart transplant recipients [108][109][110].…”

Section: Hypertensionmentioning

confidence: 99%

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Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

Munagala¹,

Phancao²

2018

obm.transplant

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Heart transplant remains the gold standard therapy for patients with end stage heart disease and offers improved survival and quality of life. Significant progress has been achieved in improving one-year mortality after heart transplantation. Nonetheless, longterm graft survival has not changed significantly over the past few decades. Long term survival of heart transplant recipients is limited by chronic rejection, cardiac allograft vasculopathy (CAV), and malignancy. CAV is a major contributor for graft failure and mortality after the first year of in heart transplant recipients. CAV is a proliferative vasculopathy characterized by diffuse myointimal hyperplasia and progressive narrowing of the graft vessels. Both immune dependent and independent factors have been shown to contribute to the pathogenesis of CAV. Understanding these risk factors is essential in developing preventative and therapeutic strategies. Angiography with Intravascular ultrasound has become the key diagnostic tool in the early detection of CAV as well as prognostication. Echocardiographic assessment of allograft function in conjunction with coronary angiographic findings are used in assessing the severity of CAV. Adjustment of immunosuppression and statins remain the initial steps in the management of CAV. Retransplantation is the definitive treatment for severe CAV, however, the paucity of organs along with increased mortality associated with retransplantation makes it a less desirable option. Remarkable progress has been achieved in the understanding of pathogenesis, risk factors for CAV and plaque morphology. Nevertheless, significant knowledge gaps persist in scientific understanding of risk factors, pathogenesis, prevention and treatment of CAV. Further research is warranted to fill these gaps, develop diagnostic modalities to facilitate early detection of CAV, and management strategies to Improve graft tolerance and immune modulation. This review focuses on summarizing the pathogenesis and risk factors for CAV.

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Section: Hypertensionmentioning

confidence: 99%

Section: Hypertensionmentioning

confidence: 99%

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

Munagala¹,

Phancao²

2018

obm.transplant

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“…6,11,12 The excess risk of hypertension is attributable primarily to the use of calcineurin inhibitors (CIs) because of both direct effects and the associated renal insufficiency. 13,14 Although both are CIs, the incidence of hypertension is lower in patients treated with tacrolimus than with cyclosporine A (CSA).…”

Section: Hypertensionmentioning

confidence: 99%

Drug Therapy in the Heart Transplant Recipient

et al. 2005

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“…Infections and transplanted organ rejection were the main causes of death at that time 6 . Since 1981, with the introduction of cyclosporine in the immunosuppressive therapeutic scheme, short-and long-term survival after cardiac transplantation have been significantly increased 5,8,9 . In a two-year follow-up after transplantation, the survival rate increased from 58% to 75% with the use of cyclosporine, when compared with the conventional immunosuppressive therapy (azathioprine and prednisone) 10 .…”

mentioning

confidence: 99%

“…The understanding of immunological responses to transplanted tissues, as well as the development of immunosuppressive therapy, has contributed to improvement in the results of cardiac transplantation in the last few years. In addition, the improvement in the diagnosis and treatment of infections and the routine use of endomyocardial biopsy, thus allowing monitoring of graft rejection 5 , also play important roles. Before cyclosporine, immunosuppression following cardiac transplantation was based upon the use of azathioprine and prednisone.…”

mentioning

confidence: 99%