Diagnosis and Management of Cardiac Allograft Vasculopathy (Chronic Rejection)

The greatest impediment to long-term survival for adult and pediatric heart transplant recipients is the development of an accelerated form of coronary artery disease[1]–[4]. This is variously termed chronic allograft vasculopathy, chronic allograft coronary artery disease, or chronic rejection. This disease was reported in the original preclinical animal experiments, and subsequently in the early human heart transplant recipients at Stanford, USA 6.7 and Cape Town, South Africa”. The incidence of this disease has been estimated at 10% per year post-transplant[4],[9]’[11]. Although cyclosporin has been associated with an improvement in 1- and 5-year graft survival, as well as a decrease in death due to rejection, it has not had an impact on reducing the incidence of allograft coronary artery disease (ACAD)[12]’[15] in adults, but increased immunosuppression may decrease the incidence in pediatric patients[15].