Cardiac allograft vasculopathy natural history, complications and prognosis
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Cardiac allograft vasculopathy Microchapters |
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Differentiating Cardiac allograft vasculopathy from other Diseases |
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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
Natural History
- CAV is a slowly progressive disease of the graft vessels. However it may progress rapidly in some post-transplant patients. For example, about 7% of patients from the Cardiac Transplant Research Database had severe disease that progressed rapidly by the end of 5 years.
- In a few years post-transplant, the disease progresses from clean coronary vasculature to diffusely diseased, obstructive pattern.
- Late onset of CAV is infrequent. The process of development of CAV is rather slow in those who develop CAV 10 years post-transplant.
Complications
Most of the complications of CAV are related to myocardial hypoperfusion. These include:
- Graft failure
- Myocardial infarction
- Sudden death
- Congestive heart failure (sometimes in the form of rapidly developing systolic failure)
- Arrhythmias
Prognosis
- Overall data from 1982 up to June 2011 shows 1 year survival of 81% and 5 year survival of 69%, with median survival of 10 years for all and 13 years for those surviving until the end of first year. The most recent cohort of patients show unadjusted 1 year survival of 84%.
- The survival curve demonstrates a steep fall in survival in the first 6 months post-transplant. Thereafter, it steadily decreases by 3.5% per year and continues to do so well beyond 15 years. However, the risk adjusted Kaplan-Meier curves suggests a significant improvement in long term survival in recent years.
- Re-transplantation: Patients who underwent re-transplantation between 2002 to 2006, who were more than 12 months from their index transplantation had a 1 year survival of approximately 85%, which is the same as index transplants performed during that period.
Causes of death
The following table outlines the common causes of death in post cardiac transplant patients [1]:
| First 30 days post-transplant | From 1 month to 12 months post-transplant | After 5 years post-transplant |
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References
- ↑ Taylor DO, Stehlik J, Edwards LB, Aurora P, Christie JD, Dobbels F; et al. (2009). "Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Heart Transplant Report-2009". J Heart Lung Transplant. 28 (10): 1007–22. doi:10.1016/j.healun.2009.08.014. PMID 19782283.