Cardiac allograft vasculopathy natural history, complications and prognosis: Difference between revisions
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* The survival curve demonstrates a steep fall in survival in the first 6 months post-transplant. Thereafter, it steadily decreases by 3.5% per year and continues to do so well beyond 15 years. Presence of CAV is the strongest predictor of mortality in patients who survive beyond 1 year post-transplant. | * The survival curve demonstrates a steep fall in survival in the first 6 months post-transplant. Thereafter, it steadily decreases by 3.5% per year and continues to do so well beyond 15 years. Presence of CAV is the strongest predictor of mortality in patients who survive beyond 1 year post-transplant. | ||
* The ISHLT Registry showed that CAV together with late graft failure was responsible for about 33% of deaths 5 years post-transplant. | * The ISHLT Registry showed that CAV together with late graft failure was responsible for about 33% of deaths 5 years post-transplant. | ||
* Also the survival of patients with CAV has in fact improved over the last decade. | * Also the survival of patients with CAV has in fact improved over the last decade. | ||
==References== | ==References== | ||
Revision as of 04:02, 1 October 2014
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Cardiac allograft vasculopathy Microchapters |
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Differentiating Cardiac allograft vasculopathy from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Cardiac allograft vasculopathy natural history, complications and prognosis On the Web |
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American Roentgen Ray Society Images of Cardiac allograft vasculopathy natural history, complications and prognosis |
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FDA on Cardiac allograft vasculopathy natural history, complications and prognosis |
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CDC on Cardiac allograft vasculopathy natural history, complications and prognosis |
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Cardiac allograft vasculopathy natural history, complications and prognosis in the news |
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Directions to Hospitals Treating Cardiac allograft vasculopathy |
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
Natural History
- CAV is a slowly progressive disease of the graft vessels. However it may progress rapidly in some post-transplant patients. For example, about 7% of patients from the Cardiac Transplant Research Database had severe disease that progressed rapidly by the end of 5 years.
- In a few years post-transplant, the disease progresses from clean coronary vasculature to diffusely diseased, obstructive pattern.
- Late onset of CAV is infrequent. The process of development of CAV is rather slow in those who develop CAV 10 years post-transplant.
Complications
Most of the complications of CAV are related to myocardial hypoperfusion. These include:
- Graft failure
- Myocardial infarction
- Sudden death
- Congestive heart failure (sometimes in the form of rapidly developing systolic failure)
- Arrhythmias
Prognosis
- All-cause mortality data from 1982 up to June 2011 shows 1 year survival of 81% and 5 year survival of 69%, with median survival of 10 years for all and 13 years for those surviving until the end of first year. The most recent cohort of patients show unadjusted 1 year survival of 84%.
- The survival curve demonstrates a steep fall in survival in the first 6 months post-transplant. Thereafter, it steadily decreases by 3.5% per year and continues to do so well beyond 15 years. Presence of CAV is the strongest predictor of mortality in patients who survive beyond 1 year post-transplant.
- The ISHLT Registry showed that CAV together with late graft failure was responsible for about 33% of deaths 5 years post-transplant.
- Also the survival of patients with CAV has in fact improved over the last decade.