Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

Clarke, Brian; Khush, Kiran K.

doi:10.5772/27421

Cited by 3 publications

(4 citation statements)

References 71 publications

(64 reference statements)

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“…Cardiac allograft vasculopathy is the predominant form of chronic rejection in HT . Both immune and nonimmune mechanisms drive this process, resulting in inflammation and endothelial injury in the transplanted graft.…”

Section: Classification System For the Severity Of Cardiac Allograft mentioning

confidence: 99%

“…Mode of death is also an important consideration, as gunshot wounds to the head, head trauma, and intracranial hemorrhage are more commonly associated with CAV. In the transplant recipient, high‐grade cellular rejection, antibody‐mediated rejection, and CMV infection also positively influence CAV progression …”

Section: Classification System For the Severity Of Cardiac Allograft mentioning

confidence: 99%

“…Patients with CAV initially present with either acute ischemia or low‐output heart failure and describe chest pain, shortness of breath, and/or decreased exercise tolerance, often with a worsening of ejection fraction . The most clinically useful modality for diagnosing CAV is coronary angiography, which allows an assessment of the degree of luminal narrowing .…”

Section: Classification System For the Severity Of Cardiac Allograft mentioning

confidence: 99%

“…Inflammation and rejection are frequently associated with incident CAV . Allorecognition promotes infiltration of macrophages, T‐lymphocytes, alloreactive antibodies, and proinflammatory cytokines that contribute to endothelial dysfunction and smooth muscle proliferation.…”

Section: Immunosuppressive Regimensmentioning

confidence: 99%

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Medication Management of Cardiac Allograft Vasculopathy After Heart Transplantation

2015

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Cardiac allograft vasculopathy (CAV) is a common complication following heart transplantation (HT), resulting in diminished graft survival. The preferred strategy for preventing CAV is optimal medical management; however, for patients who develop CAV, delaying disease progression through effective medication management is equally important. A review of the literature regarding medication management of CAV was conducted via a search of the MEDLINE database. Studies were included if they were published in English, conducted in humans ≥ 18 years of age or older, and used noninvestigational medications. Immunosuppressive medications such as the antiproliferative mycophenolate, the calcineurin inhibitor tacrolimus, and the proliferation signal inhibitors sirolimus and everolimus have been shown to prevent the development of CAV. Certain cardiovascular medications, such as HMG-CoA reductase inhibitors (statins), gemfibrozil, calcium channel blockers, and angiotensin-converting enzyme inhibitors, have also demonstrated efficacy in preventing this disease process. Prevention of CAV has also been observed with prophylaxis against cytomegalovirus infection and antioxidant medications. Despite being commonly used in HT patients, neither antiplatelet agents nor glycemic control have proved effective at preventing CAV. Only sirolimus has been shown to arrest the progress of existing CAV.

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Section: Classification System For the Severity Of Cardiac Allograft mentioning

confidence: 99%

Section: Classification System For the Severity Of Cardiac Allograft mentioning

confidence: 99%

Section: Classification System For the Severity Of Cardiac Allograft mentioning

confidence: 99%

Section: Immunosuppressive Regimensmentioning

confidence: 99%

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Medication Management of Cardiac Allograft Vasculopathy After Heart Transplantation

2015

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Transplantatvaskulopathie nach Herztransplantation

Kuckhahn

Ramsperger-Gleixner

Ensminger

et al. 2019

Z Herz- Thorax- Gefäßchir

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Effects of Immunosuppressive agents on neutrophils inflammatory response in humans: An inflammatory perspective on coronary allograft vasculopathy

White

2016

Inflamm Cell Signal

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Cardiac transplantation (CTx) has improved survival in patients with advanced heart failure. Unfortunately, the conditional survival remains less than 15 years. The primary cause of mortality at 5 years following a CTx is the development of accelerated coronary atherosclerosis named coronary allograft vasculopathy (CAV). The neutrophils likely play an important role in this diffuse inflammatory process. Nevertheless, the contribution of the neutrophils on the pathogenesis of CAV is poorly understood. Regardless of their essential contribution for the prevention of graft rejection, immunosuppressive drugs (IDs) may have detrimental effects via some pro-inflammatory activities. This review presents the role of neutrophils on vascular inflammation and on the biologic effects of diverse immunosuppressive agents including mTOR inhibitors in the context of the pathophysiology of CAV. We investigated the impact of different IDs on the inflammatory responses of isolated human neutrophils harvested from healthy controls and herein, we reported on some novel characteristics of everolimus (EVE) on isolated neutrophils in comparison with other immunosuppressive agents. These biologic effects may contribute to their beneficial effects on the allograft vasculature and consequently on the prevention of CAV.

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Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

Cited by 3 publications

References 71 publications

Medication Management of Cardiac Allograft Vasculopathy After Heart Transplantation

Medication Management of Cardiac Allograft Vasculopathy After Heart Transplantation

Transplantatvaskulopathie nach Herztransplantation

Effects of Immunosuppressive agents on neutrophils inflammatory response in humans: An inflammatory perspective on coronary allograft vasculopathy

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