Long-Term Mortality After Cardiac Allograft Vasculopathy

Agarwal, Shikhar; Parashar, Akhil; Kapadia, Samir; Tuzcu, E. Murat; Modi, Dhruv; Starling, Randall C.; Oliveira, Guilherme H.

doi:10.1016/j.jchf.2014.01.003

Cited by 49 publications

(33 citation statements)

References 28 publications

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“…An important finding of our study was that not only is early CAV diagnosis at four years associated with decreased long-time survival, but also that even mild coronary lesions, scored as CAV grade 1, represent a negative prognostic factor. Although the majority of studies are directed to more advanced degrees of CAV, which are also amenable to interventions, one other recent report showed that persistent mild coronary lesions have a negative prognostic impact [2, 21]. This finding emphasises the role of preventive measures immediately after transplantation, before even mild coronary disease may develop.…”

Section: Discussionmentioning

confidence: 99%

Cardiac allograft vasculopathy in Dutch heart transplant recipients

et al. 2016

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BackgroundCardiac allograft vasculopathy (CAV) is a multifactorial disease and a major cause of graft failure after heart transplantation. However, the impact of CAV may vary according to the definition and the regional differences in transplantation settings.ObjectivesWe sought to assess CAV prevalence, predictors and prognosis in Dutch heart transplant recipients based on coronary angiography, following the 2010 standard nomenclature of the International Society for Heart and Lung Transplantation.MethodsPatients ≥18 years who underwent heart transplantation at our centre with at least one coronary angiography during follow-up were included in the analysis. Clinical variables were collected prospectively.ResultsAmong 495 analysed recipients, there were 238 (48 %) with CAV. The prevalence of CAV was 18, 47 and 70 % at 4, 12 and 20 years, respectively. In the multivariable proportional hazards regression analysis, only male donor gender and increasing donor age were significantly associated with the risk of CAV. The long-term prognosis of the patients with CAV at fourth-year angiography was significantly worse as compared with that of CAV-free patients, independently of the severity of CAV (p < 0.001).ConclusionThe prevalence of CAV increased gradually over time, with a similar trend as in other registries. Post-transplant survival is decreased in patients with any degree of early CAV, indicating that management strategies should start with donor selection and preventive measures immediately after transplantation.

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Section: Discussionmentioning

confidence: 99%

Cardiac allograft vasculopathy in Dutch heart transplant recipients

et al. 2016

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“…Compared to those without CAV, patients with mild forms (ISHLT CAV1) have a two-fold risk of death, while patients with severe CAV (ISHLT CAV3) have a 15 times higher mortality. 2 Nevertheless, angiography is limited in its ability to detect CAV because it provides only a “lumengram”, failing to provide information about arterial wall thickening and coronary blood flow. Furthermore, there is significant inter-observer variation in angiographic grading.…”

Section: Invasive Testingmentioning

confidence: 99%

“…92 In a single center study, patients with ISHLT CAV 3 that was amenable to PCI and who underwent PCI had a decreased odds of death at two (OR 0.26, 95% CI 0.08–0.82) and five years (OR 0.28, 95% CI 0.09–0.93) compared to patients with ISHLT CAV 3 not amenable to PCI. 93 Thus it is reasonable to perform PCI for CAV that is amenable to PCI as a palliative treatment.…”

Section: Treatmentmentioning

confidence: 99%

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New developments for the detection and treatment of cardiac vasculopathy

Clerkin

Ali²,

Mancini³

2017

Current Opinion in Cardiology

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Purpose of Review Cardiac allograft vasculopathy (CAV) is a major limitation to long term survival after heart transplantation. Innovative new techniques to diagnose CAV have been applied to detect disease. This review will examine the current diagnostic and treatment options available to clinicians for CAV. Recent Findings Diagnostic modalities addressing the pathophysiology underlying CAV (arterial wall thickening and decreased coronary blood flow) improve diagnostic sensitivity when compared to traditional (angiography and dobutamine stress echocardiography) techniques. Summary Limited options are available to prevent and treat CAV; however progress has been made in making an earlier and more accurate diagnosis. Future research is needed to identify the optimal time to modify immunosuppression and investigate novel treatments for CAV.

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“…5,41,55,64,72 Long-term survival in patients with CAV amenable to PCI is greater than that in those with severe CAV not amenable to PCI. 73 Fewer OHT recipients with CAV are candidates for coronary artery bypass grafting (CABG) than for PCI, but the highly-selective CAV patients undergoing CABG may have favorable outcomes. 5,44,55 CAV is the most common indication for retransplantation, which remains the definitive therapy when CAV is not amenable to revascularizations (Table 3).…”

mentioning

confidence: 99%

Transplant coronary heart disease: challenges and solutions

Jentzer¹,

Hickey²,

Khandhar³

2014

TRRM

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Cardiac allograft vasculopathy (CAV) remains one of the leading causes of death and graft failure after heart transplantation. A variety of causes, including donor heart characteristics, recipient risk factors, and immune-mediated influences, are associated with developing CAV. In this review, we will focus on the pathophysiology of developing CAV and various methods to screen for this condition. The pathogenesis of CAV likely involves repeated injuries to the endothelium from a variety of factors such as cellular-mediated rejection, and alloimmune factors, including antibody-mediated injury, ischemia-reperfusion injury at time of transplant, cytomegalovirus infections, immunosuppression medications, systemic inflammation, and traditional atherosclerosis risk factors. Patients with significant CAV are often asymptomatic, and therefore early detection by routine screening prior to graft dysfunction is crucial. There are a variety of invasive, noninvasive, and blood tests that have been studied as screening methods, and we will discuss the role of each of these in this review article. Although some treatment regimens have been established for CAV, this is an area where further studies and research are necessary.

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Long-Term Mortality After Cardiac Allograft Vasculopathy

Abstract: Worsening severity of CAV was associated with progressively worse long-term survival among heart transplant recipients. Among patients with CAV, long-term survival in those with CAV amenable to PCI was greater than that in those with severe CAV not treatable with PCI.

Cited by 49 publications

References 28 publications

Cardiac allograft vasculopathy in Dutch heart transplant recipients

Cardiac allograft vasculopathy in Dutch heart transplant recipients

New developments for the detection and treatment of cardiac vasculopathy

Transplant coronary heart disease: challenges and solutions

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