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

Once CAV has developed, pharmacologic options to halt progression are limited. Moreover, outcomes resulting from available treatment have been disappointing. Retransplantation is the only definitive treatment of established CAV. Ideal regimen should not affect the lipid profile, blood pressures and renal function, and should have a positive impact on hemodynamics.

Medical Therapy

Treatment option for established CAV include:

Pharmacological Management	Non-pharmacological Interventions
Sirolimus Everolimus	Retransplantation Percutaneous coronary interventions Coronary artery bypass grafting (CABG) Transmyocardial revascularization Heparin induced/mediated extracorporeal LDL plasmapheresis (HELP)

Pharmacologic Management

High Dose Immunosuppressive Therapy

Lamich and colleagues ^[1] studied the effects of augmented immunosuppressive therapy on progression of established CAV in a prospective trial of 76 cardiac allograft recipients. They concluded that the likelihood of CAV regression is higher when treatment was instituted within one year of transplant (92%) compared to after one year (40%) (P=0.033).
However, this is not routinely practiced as the risks of high dose immunosuppressive therapy outweighs the benefits.

References

↑ Lamich R, Ballester M, Martí V, Brossa V, Aymat R, Carrió I; et al. (1998). “Efficacy of augmented immunosuppressive therapy for early vasculopathy in heart transplantation”. J Am Coll Cardiol. 32 (2): 413–9. PMID 9708469.

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[pmid9708469-1] Lamich R, Ballester M, Martí V, Brossa V, Aymat R, Carrió I; et al. (1998). “Efficacy of augmented immunosuppressive therapy for early vasculopathy in heart transplantation”. J Am Coll Cardiol. 32 (2): 413–9. PMID 9708469.

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