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Keywords

 

Authors

  1. Rhodes, Lana Renae RN, MSN, NP

Abstract

The purpose of this article is to discuss the pathogenesis, characteristics, and treatment modalities for heart transplant recipients with cardiac allograft vasculopathy (CAV). Cardiac transplantation has become an acceptable mainstream treatment for end-stage cardiac disease. Unfortunately, CAV is the leading cause of death after the first year of transplant. CAV is an accelerated form of obliterative coronary artery disease that occurs in the heart transplant recipient. Currently, retransplantation is the only definitive treatment. Ethical concerns and the shortage of donor organs present a huge obstacle to retransplantation and the long-term outcome of heart transplant recipients.

 

CARDIAC TRANSPLANTATION has become, with great success, an acceptable mainstream treatment for end-stage cardiac disease. Coronary allograft vasculopathy (CAV), however, presents a major roadblock to long-term survival in the heart transplant recipient. CAV is an accelerated form of obliterative coronary artery disease that occurs in the heart transplant recipient. 1 First noted among the original heart transplant recipients at Stanford in the late 1960s, the incidence of CAV has not declined, despite the great advances obtained in controlling rejection and infection episodes. 2 Incidence is 5% to 10% per year of the postoperative period, reaching 50% by 5 years posttransplant. 1,3

 

The patient with CAV has silent ischemia due to the denervated heart. Classical symptoms include congestive heart failure, myocardial infarction, and sudden cardiac death. 4 Because of the nature of the symptoms, and given that some patients may not experience any symptoms, follow-up with periodic coronary angiogram and intravascular ultrasound are imperative to detect which patients have CAV.

 

Various risk factors, both immunologic and nonimmunologic, have been implicated in the development and progression of CAV. Although prophylaxis therapies exist, the only effective treatment for CAV is retransplantation. Serious ethical concerns swarm the issue of retransplantation because of the overwhelming shortage of donor organs. In addition, morbidity and mortality rates following retransplantation are much greater than that of primary transplantation. 1,5,6