Cardiac allograft vasculopathy medical therapy: Difference between revisions
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* About 60% of the repeat transplantation procedures performed are due to graft failure secondary to CAV <ref name="pmid16686747">{{cite journal| author=Mehra MR| title=Contemporary concepts in prevention and treatment of cardiac allograft vasculopathy. | journal=Am J Transplant | year= 2006 | volume= 6 | issue= 6 | pages= 1248-56 | pmid=16686747 | doi=10.1111/j.1600-6143.2006.01314.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16686747 }} </ref>. It is a higher risk procedure and raises significant ethical concerns primarily because of scarcity of heart transplant donors <ref name="pmid12909465">{{cite journal| author=Radovancevic B, McGiffin DC, Kobashigawa JA, Cintron GB, Mullen GM, Pitts DE et al.| title=Retransplantation in 7,290 primary transplant patients: a 10-year multi-institutional study. | journal=J Heart Lung Transplant | year= 2003 | volume= 22 | issue= 8 | pages= 862-8 | pmid=12909465 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12909465 }} </ref>. | * About 60% of the repeat transplantation procedures performed are due to graft failure secondary to CAV <ref name="pmid16686747">{{cite journal| author=Mehra MR| title=Contemporary concepts in prevention and treatment of cardiac allograft vasculopathy. | journal=Am J Transplant | year= 2006 | volume= 6 | issue= 6 | pages= 1248-56 | pmid=16686747 | doi=10.1111/j.1600-6143.2006.01314.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16686747 }} </ref>. It is a higher risk procedure and raises significant ethical concerns primarily because of scarcity of heart transplant donors <ref name="pmid12909465">{{cite journal| author=Radovancevic B, McGiffin DC, Kobashigawa JA, Cintron GB, Mullen GM, Pitts DE et al.| title=Retransplantation in 7,290 primary transplant patients: a 10-year multi-institutional study. | journal=J Heart Lung Transplant | year= 2003 | volume= 22 | issue= 8 | pages= 862-8 | pmid=12909465 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12909465 }} </ref>. | ||
* Prognosis: One year survival has improved in recent years, but continues to be inferior compared to primary transplants (79% in re-transplant group compared to 85% in primary transplant group) <ref name="pmid10972218">{{cite journal| author=Srivastava R, Keck BM, Bennett LE, Hosenpud JD| title=The results of cardiac retransplantation: an analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry. | journal=Transplantation | year= 2000 | volume= 70 | issue= 4 | pages= 606-12 | pmid=10972218 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10972218 }} </ref>. | * Prognosis: One year survival has improved in recent years, but continues to be inferior compared to primary transplants (79% in re-transplant group compared to 85% in primary transplant group) <ref name="pmid10972218">{{cite journal| author=Srivastava R, Keck BM, Bennett LE, Hosenpud JD| title=The results of cardiac retransplantation: an analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry. | journal=Transplantation | year= 2000 | volume= 70 | issue= 4 | pages= 606-12 | pmid=10972218 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10972218 }} </ref>. | ||
====Percutaneous Coronary Intervention==== | |||
* This procedure is limited only to a selected group of patients with focal disease in a single artery. Moreover, the number of patients who benefit are small. | |||
* Incidence of re-stenosis is high, ranging from 20 to 60% as reported in various studies. | |||
* [[Intracoronary stenting]] appears to have lower rate of re-stenosis as compared to [[coronary angioplasty]] alone. | |||
* Concomitant use of high dose immunosuppressive therapy with [[azathioprine]] and [[mycophenolate]] have shown to significantly reduce the rate of re-stenosis <ref name="pmid15172400">{{cite journal| author=Benza RL, Zoghbi GJ, Tallaj J, Brown R, Kirklin JK, Hubbard M et al.| title=Palliation of allograft vasculopathy with transluminal angioplasty: a decade of experience. | journal=J Am Coll Cardiol | year= 2004 | volume= 43 | issue= 11 | pages= 1973-81 | pmid=15172400 | doi=10.1016/j.jacc.2004.02.045 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15172400 }} </ref>. | |||
==References== | ==References== | ||
Revision as of 19:58, 13 December 2014
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Cardiac allograft vasculopathy Microchapters |
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Differentiating Cardiac allograft vasculopathy from other Diseases |
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Cardiac allograft vasculopathy medical therapy On the Web |
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Risk calculators and risk factors for Cardiac allograft vasculopathy medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
Medical Therapy
Pharmacologic Management
Nonpharmacologic Interventions
- Retransplantation
- Percutaneous coronary interventions
- Coronary artery bypass grafting
- Transmyocardial revascularization
- Heparin induced/mediated extracorporeal LDL plasmapheresis (HELP)
Retransplantation
- Retransplantation is the only definitive treatment for CAV. It is associated with satisfactory survival in patients with CAV.
- About 60% of the repeat transplantation procedures performed are due to graft failure secondary to CAV [1]. It is a higher risk procedure and raises significant ethical concerns primarily because of scarcity of heart transplant donors [2].
- Prognosis: One year survival has improved in recent years, but continues to be inferior compared to primary transplants (79% in re-transplant group compared to 85% in primary transplant group) [3].
Percutaneous Coronary Intervention
- This procedure is limited only to a selected group of patients with focal disease in a single artery. Moreover, the number of patients who benefit are small.
- Incidence of re-stenosis is high, ranging from 20 to 60% as reported in various studies.
- Intracoronary stenting appears to have lower rate of re-stenosis as compared to coronary angioplasty alone.
- Concomitant use of high dose immunosuppressive therapy with azathioprine and mycophenolate have shown to significantly reduce the rate of re-stenosis [4].
References
- ↑ Mehra MR (2006). "Contemporary concepts in prevention and treatment of cardiac allograft vasculopathy". Am J Transplant. 6 (6): 1248–56. doi:10.1111/j.1600-6143.2006.01314.x. PMID 16686747.
- ↑ Radovancevic B, McGiffin DC, Kobashigawa JA, Cintron GB, Mullen GM, Pitts DE; et al. (2003). "Retransplantation in 7,290 primary transplant patients: a 10-year multi-institutional study". J Heart Lung Transplant. 22 (8): 862–8. PMID 12909465.
- ↑ Srivastava R, Keck BM, Bennett LE, Hosenpud JD (2000). "The results of cardiac retransplantation: an analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry". Transplantation. 70 (4): 606–12. PMID 10972218.
- ↑ Benza RL, Zoghbi GJ, Tallaj J, Brown R, Kirklin JK, Hubbard M; et al. (2004). "Palliation of allograft vasculopathy with transluminal angioplasty: a decade of experience". J Am Coll Cardiol. 43 (11): 1973–81. doi:10.1016/j.jacc.2004.02.045. PMID 15172400.