Cardiac allograft vasculopathy : the silent, long-suffering enemy

Cardiac transplantation is currently the preferred choice of treatment for end-stage cardiac disease. Despite great advances in controlling rejection and infection episodes, cardiac allograft vasculopathy (CAV) remains the leading cause of death after the first year of transplantation. CAV is an accelerated form of obliterative coronary artery disease that occurs in the heart transplant recipient. Currently, retransplantation is the only definitive treatment for patients with CAV and bioethical concerns of the growing donor shortage and increasing demand have served as a major obstacle in the long-term care for these patients. This short review will discuss the various molecular etiologies of CAV, emphasizing the endothelium as a critical site of injury that is capable of inducing CAV pathogenesis. Potential preventative, existing and novel immunosuppression regimens for treating CAV will also be reviewed.