Transplant Vasculopathy Versus Native Atherosclerosis: Similarities and Differences

被引:1
|
作者
Weis, Michael [1 ]
Weis, Mara [1 ]
机构
[1] Univ Munich, Krankenhaus Neuwittelsbach, Dept Internal Med 1, D-80639 Munich, Germany
关键词
CARDIAC ALLOGRAFT VASCULOPATHY; CORONARY ENDOTHELIAL DYSFUNCTION; HEART-TRANSPLANTATION; INTERNATIONAL SOCIETY; LUNG TRANSPLANTATION; VASOMOTOR FUNCTION; PROGNOSTIC VALUE; ARTERY-DISEASE; DONOR; ACTIVATION;
D O I
10.1097/TP.0000000000004853
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Cardiac allograft vasculopathy (CAV) is one of the leading causes of graft failure and death after heart transplantation. Alloimmune-dependent and -independent factors trigger the pathogenesis of CAV through activation of the recipients' (and to a lesser extent donor-derived) immune system. Early diagnosis of CAV is complicated by the lack of clinical symptoms for ischemia in the denervated heart, by the impact of early functional coronary alterations, by the insensitivity of coronary angiography, and by the involvement of small intramyocardial vessels. CAV in general is a panarterial disease confined to the allograft and characterized by diffuse concentric longitudinal intimal hyperplasia in the epicardial coronary arteries and concentric medial disease in the microvasculature. Plaque composition in CAV may include early fibrous and fibrofatty tissue and late atheromatous calcification. In contrast, native coronary atherosclerosis usually develops over decades, is focal, noncircumferential, and typically diminishes proximal parts of the epicardial vessels. The rapid and early development of CAV has an adverse prognostic impact, and current prevention and treatment strategies are of limited efficacy compared with established strategies in native atherosclerosis. Following acute coronary syndromes, patients after heart transplantation were more likely to have accompanying cardiogenic shock and higher mortality compared with acute coronary syndromes patients with native hearts.
引用
收藏
页码:1342 / 1349
页数:8
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