Outcomes of Bare Metal versus Drug-eluting Stents in Allograft Vasculopathy

Reddy, Proddutur R.; Gulati, Akhil; Steen, Lowell; Sinacore, James; Leya, Ferdinand; Heroux, Alain

doi:10.1016/j.healun.2008.08.005

Cited by 24 publications

(18 citation statements)

References 28 publications

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“…Chronic rejection of cardiac allografts is manifested by cardiac allograft vasculopathy (CAV), characterized by occlusion of coronary vessels. Despite its significant utility in improving outcomes of patients with non-transplant coronary artery disease, drug-eluting stents still seem to be of limited value in treating CAV following cardiac transplantation [19]. The 5-year incidence of CAV is 30-40% and several mechanisms have been proposed to explain the underlying process [20].…”

Section: Evidence For Alloimmunity In Chronic Rejectionmentioning

confidence: 99%

Antihuman leukocyte antigen antibody-induced autoimmunity: role in chronic rejection

Nath¹,

Basha

Mohanakumar

2010

Current Opinion in Organ Transplantation

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Purpose of review-We provide evidence for the role of de novo development of immune responses to self-antigens in the post-transplant period and its possible induction by alloimmunity in the pathogenesis of chronic rejection following lung, heart and kidney transplantation. This review details recent findings for the two distinct yet inter-dependent immune processes in the immunepathogenesis of chronic rejection.Recent findings-The contribution of both humoral and cell mediated allo-immune responses against mismatched donor histocompatibility antigens (HLA) in the pathogenesis of chronic rejection is well established. Recent studies have focused on development of immune responses to selfantigens during the post-transplant period and its correlation with chronic rejection. These selfantigens include myosin and vimentin in cardiac, K-alpha-1-tubulin and collagen-V in lung and angiotensin II type 1 receptor, collagen-IV and VI in kidney transplants. During the post-transplant period, the development of immune responses to self-antigens is facilitated by induction of a distinct subset of auto-reactive T-helper cells referred to as Th17 cells.Summary-Following organ transplantation, tissue injury and remodeling inflicted by Abs to HLA antigens is conducive to develop autoimmunity. Antibodies (Abs) to HLA and self-antigens are detectable in the serum of transplant recipients who develop chronic rejection. Anti-HLA Abs are often present transiently but precede the development of Abs to self-antigens.

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Section: Evidence For Alloimmunity In Chronic Rejectionmentioning

confidence: 99%

Antihuman leukocyte antigen antibody-induced autoimmunity: role in chronic rejection

Nath¹,

Basha

Mohanakumar

2010

Current Opinion in Organ Transplantation

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“…3 This might also be the reason why the authors describe a low rate of "significant vasculopathy" (percutaneous coronary intervention, myocardial infarction, death due to vasculopathy), whereas we found stenotic lesions to affect about 20% of patients. The terms "any lesion" and "significant stenosis," without description or reference, remain subjective and might not reflect major disease because non-stenotic, peripheral lesions (type B2 lesions) develop in most heart transplant recipients.…”

mentioning

confidence: 59%

Quilty Effect, Acute Cellular Rejection, and Transplant Vasculopathy: Still Controversial

Hiemann

Hetzer

Meyer

2009

The Journal of Heart and Lung Transplantation

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“…1 In their study of 42 patients, they found angiographic and clinical outcomes to be similar at 1 year after intervention and concluded that DES are not superior to BMS in preventing adverse outcomes. We agree with the authors that the small patient population (n ϭ 42) is a major study limitation, and we would appreciate comments from Reddy and colleagues on the following suggestions.…”

mentioning

confidence: 98%