Cardiac allograft vasculopathy risk factors

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]

Cardiac allograft vasculopathy (CAV) is characterized by concentric intimal proliferation leading to diffuse narrowing of the entire length of the epicardial vessel. Immune mediated processes are thought to be the biggest risk factors driving the process of graft vessel narrowing. However, traditional risk factors for coronary artery disease such as hyperlipidemia, diabetes mellitus, hypertension and smoking have been shown to play a considerable role in the pathogenesis of CAV.

Few immune mediated risk factors reported include:

• Increased levels of B cell antibodies
• Increased levels of HLA-antibodies
• Acute cellular and humoral mediated rejection
• Sensitization to monoclonal antibody OKT3
• Cytomegalovirus infection
• Elevated soluble interleukin-2 receptor levels

Non-immune risk factors include:

• Hyperlipidemia
• Diabetes mellitus
• Hypertension
• Smoking
• Older donor age
• Male donor
• Recepient age
• Recepient gender
• Obesity
• Pretranplant diagnosis
• Donor ischemic time

LDL and triglycerides as risk factors for CAV have been studied more in depth. LDL oxidation leads to recruitment of macrophages and lymphocytes along with increased expression of HLA antigens and interleukin receptors on T cells. This further accelerates the process of vasculopathy.

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