Cardiac allograft vasculopathy medical therapy

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Cardiac allograft vasculopathy Microchapters

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Overview

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Differentiating Cardiac allograft vasculopathy from other Diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

Medical Therapy

Pharmacologic Management

Nonpharmacologic Interventions

Retransplantation

  • Retransplantation is the only definitive treatment for CAV. It is associated with satisfactory survival in patients with CAV.
  • About 60% of the repeat transplantation procedures performed are due to graft failure secondary to CAV [1]. It is a higher risk procedure and raises significant ethical concerns primarily because of scarcity of heart transplant donors [2].
  • Prognosis: One year survival has improved in recent years, but continues to be inferior compared to primary transplants (79% in re-transplant group compared to 85% in primary transplant group) [3].

Percutaneous Coronary Intervention

  • This procedure is limited only to a selected group of patients with focal disease in a single artery. Moreover, the number of patients who benefit are small.
  • Incidence of re-stenosis is high, ranging from 20 to 60% as reported in various studies.
  • Intracoronary stenting appears to have lower rate of re-stenosis as compared to coronary angioplasty alone.
  • Concomitant use of high dose immunosuppressive therapy with azathioprine and mycophenolate have shown to significantly reduce the rate of re-stenosis [4].

References

  1. Mehra MR (2006). "Contemporary concepts in prevention and treatment of cardiac allograft vasculopathy". Am J Transplant. 6 (6): 1248–56. doi:10.1111/j.1600-6143.2006.01314.x. PMID 16686747.
  2. Radovancevic B, McGiffin DC, Kobashigawa JA, Cintron GB, Mullen GM, Pitts DE; et al. (2003). "Retransplantation in 7,290 primary transplant patients: a 10-year multi-institutional study". J Heart Lung Transplant. 22 (8): 862–8. PMID 12909465.
  3. Srivastava R, Keck BM, Bennett LE, Hosenpud JD (2000). "The results of cardiac retransplantation: an analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry". Transplantation. 70 (4): 606–12. PMID 10972218.
  4. Benza RL, Zoghbi GJ, Tallaj J, Brown R, Kirklin JK, Hubbard M; et al. (2004). "Palliation of allograft vasculopathy with transluminal angioplasty: a decade of experience". J Am Coll Cardiol. 43 (11): 1973–81. doi:10.1016/j.jacc.2004.02.045. PMID 15172400.

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