Palliation of allograft vasculopathy with transluminal angioplasty - a decade of experience

Benza, Raymond L.; Brown, Robert N.; Kirklin, James K.; Hubbard, M.; Zoghbi, Gilbert J.; McGiffin, David C.; Bourge, Robert C.; Rayburn, Barry K.; Foley, Brian A.

doi:10.1016/s1053-2498(01)00489-2

Cited by 21 publications

(32 citation statements)

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“…100 Revascularization procedures for CAV are only palliative, with no long-term survival benefit. In contrast to native atherosclerosis, stented and reference-vessel nonstented lesions in CAV appear to progress indefinitely with time, 5,113 which reflects the more aggressive and dynamic nature of CAV.…”

Section: Coronary Revascularizationmentioning

confidence: 99%

“…Multivariate predictors of freedom from restenosis were the use of stents and a higher antiproliferative immunosuppressant dose. 113 Especially in the setting of 3-vessel disease at first intervention, the 2-year freedom for death or graft loss is very low (27% compared with 74% and 75% for 1-and 2-vessel disease, respectively). 113 Most recently, drug-eluting stents have been shown to have a tendency to lower restenosis rates compared with bare-metal stents (15% versus 31%) 119 at 40 months' follow-up (Table 2).…”

Section: Percutaneous Interventionsmentioning

confidence: 99%

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Cardiac Allograft Vasculopathy

2008

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Abstract-Cardiac allograft vasculopathy (CAV) continues to limit the long-term success of cardiac transplantation.Recent insights have underscored the fact that innate and adaptive immune responses are involved in the pathogenesis of CAV. Vascular lesions are the result of cumulative endothelial injuries induced both by alloimmune responses and by nonspecific insults (including ischemia-reperfusion injury, viral infections, and metabolic disorders) in the context of impaired repair mechanisms. Intravascular ultrasound is the most sensitive method for detection of CAV, and progressive intimal thickening in the first posttransplant year identifies patients at high risk for future cardiovascular events. Encouraging results with regard to the detection of CAV by noninvasive methods should be an incentive to apply routine noninvasive imaging during mid-to long-term follow-up. Improved immunosuppressive drugs, including mycophenolate mofetil and proliferation signal inhibitors, as well as statins (in part via immunomodulation), have beneficial effects on CAV progression, although there is still a need to confirm the impact of vasodilators in improving outcome after heart transplantation. Coronary revascularization for CAV is only palliative, with no long-term survival benefit. Three main strategies for CAV prevention are currently under investigation: inhibition of growth factors and cytokines, cell therapy, and tolerance induction. However, because individual responses to an allograft change over time, assays to monitor the recipient's immune response and individualized methods for therapeutic immune modulation are clearly needed. (Circulation. 2008;117:2131-2141.)

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Section: Coronary Revascularizationmentioning

confidence: 99%

Section: Percutaneous Interventionsmentioning

confidence: 99%

Cardiac Allograft Vasculopathy

2008

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“…Several therapeutic interventions including aggressive immunosuppressive therapy, percutaneous transluminal coronary angioplasty, laser myocardial therapy, coronary artery bypass grafting, valvular repair and temporary and long term mechanical circulatory assist devices have been proposed; however, heart retransplantation (RTx) remains the only viable long-term treatment for end-stage cardiac allograft failure (4)(5)(6)(7)(8). Despite annual RTx rates of as high as 6% as reported by the 2017 ISHLT data (9), the literature on RTx is ambiguous with several studies reporting conflicting findings in regards to the survival and viability of this therapy (10,11).…”

Section: Introductionmentioning

confidence: 99%

Outcomes and survival following heart retransplantation for cardiac allograft failure: a systematic review and meta-analysis

Rizvi

Luc

Choi

et al. 2018

Ann. Cardiothorac. Surg.

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Background: Long-term efficacy of heart retransplantation (RTx) for end-stage cardiac allograft failure remains unclear given the limited worldwide experience and is an important question to elucidate given the shortage of donor organs. The aim of this systematic review was to examine the outcomes of RTx in patients with cardiac allograft failure.Methods: Electronic search was performed to identify all studies in the English literature assessing RTx for cardiac allograft failure. All identified articles were systematically assessed for inclusion and exclusion criteria.Results: Eleven studies were included for analysis, with a total of 7,791 patients. A total of 7,446 patients underwent primary heart transplantation (HTx) whereas 345 patients underwent RTx with average time from primary HTx to RTx interval of 5.03 years (95% CI: 3.13-6.94 years). There were 35.2% of patients Conclusions:Patients who underwent heart RTx had a significant lower survival when compared to those who only underwent primary HTx. There were no significant differences in post-transplantation freedom from rejection. Careful patient selection and perioperative care can make heart RTx a viable option for selected recipients.

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“…Our analysis also found several clinical factors and medications that may be important in predicting overall fibrinolytic and thrombotic activity. Given that some of these same factors also are known to either promote or mitigate both neointimal proliferation and atheromatous CAD, it is possible that these clinical factors could also influence the formation and/or progression of Tx CAD via mechanisms involving shifts in FA (26)(27)(28)(29)(30)(31)(32)(33)(34). This study is limited by the small, single center nature of the cohort and that some time points contain missing values, which could skew the significance of the time course.…”

Section: Discussionmentioning

confidence: 99%

Alterations in the Fibrinolytic Cascade Post-transplant: Evidence of a Bimodal Expression Pattern

Benza

Cavender

Barchue

et al. 2007

The Journal of Heart and Lung Transplantation

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Changes in the fibrinolytic system that occur after cardiac transplantation (CTx) and the factors which influence such changes are poorly described, yet may be ultimately important in determining the varying morphologic features of transplant related coronary artery disease (Tx CAD). Baselines demographic, as well as serial clinical information and plasma fibrinolytic levels were prospectively recorded preCTx and multiple times postCTx in 110 de novo cardiac transplant recipients. We noted a biphasic change in fibrinolytic activity over the first year of CTx with an early immediate decline in PAI-1 activity (p > 0.001) matched with stable PAP (plasmin) activity corresponding to an "enhanced" fibrinolytic state early post CTx followed by a significant increase at 6 months (p = 0.004) and 1 year (p < 0.001) in PAI-1 activity concomitant with a significant decline in PAP after 3 months (p = 0.005 at 3 months, p < 0.001 at 6 months, and p < 0.001 at 1 year) corresponding to an "impaired" fibrinolytic state late post CTx. This biphasic nature of the fibrinolytic system could account for the varying morphologic features of Tx CAD.

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Palliation of allograft vasculopathy with transluminal angioplasty - a decade of experience

Cited by 21 publications

References 0 publications

Cardiac Allograft Vasculopathy

Cardiac Allograft Vasculopathy

Outcomes and survival following heart retransplantation for cardiac allograft failure: a systematic review and meta-analysis

Alterations in the Fibrinolytic Cascade Post-transplant: Evidence of a Bimodal Expression Pattern

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