Perspectives on cardiac allograft vasculopathy.

Allograft arteriopathy, the slowly progressive, diffuse, atherosclerosis noted often after heart transplant, and also called chronic rejection, is the most common cause of late cardiac graft failure and patient death. The process is multifactorial, rooted in both immune and nonimmune factors that can be coupled to passenger atherosclerosis moved with the donor heart, as well as initially nondiseased endothelium. Great insight has emerged from experimental models and intravascular ultrasound study of patients, but treatments are still crude and produce less than optimal results. Nonetheless, it has been demonstrated that diltiazem, pravastatin, ganciclovir, newer immunosuppressive agents, and photophoresis may be helpful. In the future, better control of the allograft immunologic response will likely be the key to attenuating development of this form of atherosclerosis.