Risk factors of cardiac allograft vasculopathy

Szyguła‐Jurkiewicz, Bożena; Szczurek, Wioletta; Gąsior, Mariusz; Zembala, Marian

doi:10.5114/kitp.2015.56783

Cited by 8 publications

(13 citation statements)

References 39 publications

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“…As mentioned at the beginning, the critical influence of ischemic injury on acute and chronic allograft rejection events has been investigated for decades and was analyzed in an early clinical trial for renal transplant recipients (338,349,350). In recent years, these findings have been confirmed by others (499,558,613,666,677,692). While a variety of molecular mechanisms have been proposed to explain the phenomenon of IRI, excess production of ROS continues to receive most attention as a critical factor in the genesis of this kind of oxidative injury.…”

Section: Ischemia-reperfusion Injury and The Redox Systemmentioning

confidence: 63%

Origin and Consequences of Necroinflammation

Sarhan

Land

Tonnus

et al. 2018

Physiological Reviews

165

152

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When cells undergo necrotic cell death in either physiological or pathophysiological settings in vivo, they release highly immunogenic intracellular molecules and organelles into the interstitium and thereby represent the strongest known trigger of the immune system. With our increasing understanding of necrosis as a regulated and genetically determined process (RN, regulated necrosis), necrosis and necroinflammation can be pharmacologically prevented. This review discusses our current knowledge about signaling pathways of necrotic cell death as the origin of necroinflammation. Multiple pathways of RN such as necroptosis, ferroptosis, and pyroptosis have been evolutionary conserved most likely because of their differences in immunogenicity. As the consequence of necrosis, however, all necrotic cells release damage associated molecular patterns (DAMPs) that have been extensively investigated over the last two decades. Analysis of necroinflammation allows characterizing specific signatures for each particular pathway of cell death. While all RN-pathways share the release of DAMPs in general, most of them actively regulate the immune system by the additional expression and/or maturation of either pro- or anti-inflammatory cytokines/chemokines. In addition, DAMPs have been demonstrated to modulate the process of regeneration. For the purpose of better understanding of necroinflammation, we introduce a novel classification of DAMPs in this review to help detect the relative contribution of each RN-pathway to certain physiological and pathophysiological conditions.

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Section: Ischemia-reperfusion Injury and The Redox Systemmentioning

confidence: 63%

Origin and Consequences of Necroinflammation

Sarhan

Land

Tonnus

et al. 2018

Physiological Reviews

165

152

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“…Oxidative-antioxidative balance disorders in the prooxidative direction cause a cascade of changes that lead to damage of the vascular endothelium, constituting the main point of CAV development. Permanent smoldering, low-grade vascular inflammation, and oxidative stress cause progressive endothelial damage in the coronary arteries, leading to CAV initiation and progression [ 4 , 5 , 7 ]. To minimize damage caused by ROS, the body uses enzymatic and nonenzymatic antioxidant systems that restore the proper oxidative-antioxidant balance [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, new noninvasive sensitive and specific tools are necessary for detecting CAV early, which may result in the modification of immunosuppressive therapy, increase in statin doses, and intensive treatment of CAV-related comorbidities. There are numerous immune and nonimmune factors in the donor and recipient that are related to the presence of CAV, but a clear concept of the pathophysiological pathways associated with the development and progression of CAV is still lacking, in particular regarding the role of oxidative stress in CAV development [ 4 , 5 ]. Oxidative stress is defined as an imbalance between the production of reactive oxygen species (ROS) and the ability of antioxidant mechanisms to neutralize it [ 4 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Investigation of the Role of Oxidative Stress and Factors Associated with Cardiac Allograft Vasculopathy in Patients after Heart Transplantation

Szczurek

Gąsior

Romuk

et al. 2020

Oxidative Medicine and Cellular Longevity

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Oxidative stress is defined as an imbalance between the production of free radicals and their elimination by the antioxidant defense system. However, the role of oxidative stress in cardiac allograft vasculopathy (CAV) has not been fully understood. Therefore, this study is aimed at determining the role of oxidative-antioxidative balance disturbances in patients after HT. Furthermore, we sought to analyze factors associated with the presence of CAV, with particular emphasis placed on oxidative stress markers. The study analyzed data of 194 consecutive patients after HT who underwent routine visits in the Transplantation Clinic between 2015 and 2016. Total oxidant status (TOS) and total antioxidant capacity (TAC) were measured by the method described by Erel. The oxidative stress index (OSI) was defined as the ratio of the TOS to TAC levels. Patients’ mean age was 55.4±15.0 years, and 73.4% were men. The frequency of CAV was 50%. The area under the receiver operating characteristic curves indicated a good discriminatory power of TAC and TOS (0.8940 (0.8515-0.9365); 0.8620 (0.8126-0.9114), respectively) as well as excellent discriminatory power of OSI (0.9530 (0.9279-0.9781)) for CAV detection. Multivariate analysis of the Cox proportional hazard model confirmed that OSI (hazard ratio HR=1.294 (1.204-1.391), p<0.0001), age (HR=1.023 (1.006-1.041), p=0.0091), and high-sensitivity C-reactive protein (HR=1.049 (1.016-1.083), p=0.0151) were independently associated with CAV presence. In conclusion, TAC and TOS had a good discriminatory power and OSI had excellent strength for detecting CAV. The independent factors of CAV were higher OSI and CRP levels, as well as older recipient age.

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“…Another important risk factor for CAV is CMV infection [ 20 , 21 ]. CMV infection might act directly and indirectly in HT patients.…”

Section: Discussionmentioning

confidence: 99%

Heart Transplantation and Risk of Cardiac Vasculopathy Development: What Factors Are Important?

et al. 2017

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BackgroundThe aim of this study was to find the main risk factors for development of cardiac allograft vasculopathy (CAV), especially factors identified before the surgical procedure and factors related to the recipient profile and the medical history of the donor.Material/MethodsThere were 147 patients who had heart transplantation (HT) included in this study: mean age was 45.8±15.3 years. All study patients had coronary angiography after HT. Analyzed risk factors were: non-immunologic recipient risk factors (age of transplantation, smoking, hypertension, lipids, diabetes, obesity and weight gain after HT), immunologic recipient risk factors (acute cellular rejection (ACR), acute humoral rejection (AMR), cytomegalovirus (CMV) episodes), and donor-related risk factors (age, sex, catecholamine usage, ischemic time, compatibility of sex and blood groups, cause of death, cardiac arrest).ResultsCAV was recognized in 48 patients (CAV group); mean age 53.6±13.6 years. There were 99 patients without CAV (nonCAV group); mean age 48.3±15.5 years. A univariate Cox analysis of the development of coronary disease showed statistical significance (p<0.05) for baseline high-density lipid (HDL), ACR, AMR, CMV, and donor age. Multivariate Cox regression model confirmed that only baseline HDL, episodes of ACR, donor age, and CMV infection are significant for the frequency of CAV after HT.ConclusionsOlder donor age is highly associated with CAV development. Older donor age and low level of HDL in heart recipients with the strongest influence of immunologic risk factors (ACR, CMV infection) were linked with development of CAV.

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Risk factors of cardiac allograft vasculopathy

Cited by 8 publications

References 39 publications

Origin and Consequences of Necroinflammation

Origin and Consequences of Necroinflammation

Investigation of the Role of Oxidative Stress and Factors Associated with Cardiac Allograft Vasculopathy in Patients after Heart Transplantation

Heart Transplantation and Risk of Cardiac Vasculopathy Development: What Factors Are Important?

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