Cardiac Allograft Vasculopathy and Coronary Artery Disease Development with Orthotopic Heart Transplantation

Year 2012, Volume: 15 Issue: 2, 75 - 79, 01.02.2011

Deniz Çevirme İlker Mataracı Oğuz Konukoğlu Kaan Kırali Mehmet Balkanay

Abstract

Cardiac allograft vasculopathy is an accelerated form coronary artery disease that characterized by development of fibrous intimal hyperplasia of all coronary artery. This is a major factor determining long-term survival in heart transplantation. Three (4%) patients were developed coronary artery disease and allograft vasculopathy from orthotopik heart transplantation in 62 patients at our clinic in late follow-up. There were two of the male, one female patients and age 22, 24 and 39, respectively. Because of development in young patients multivessel disease were performed invasive procedures. Women patient was died after diagnosed one year. Two patients continued medical follow-up. Allograft vasculopathy is very diffuse pathology that invasive procedures success is limited in the treatment.

Keywords

Heart transplantation; coronary vessels; graft rejection.

Ortotopik Kalp Transplantasyonlu Hastalarda Kardiyak Allogreft Vaskülopati ve Koroner Arter Hastalığı

Abstract

Kardiyak allogreft vaskülopatisi tüm koroner arter boyunca fibröz intimal hiperplazinin gelişimi ile karakterize koroner arter hastalığının hızlandırılmış bir formudur. Kalp transplantasyonunda uzun dönem sağkalımda belirleyici majör bir faktördür. Kliniğimizde ortotopik kalp transplantasyonu uygulanmış 62 hastanın 3 (%4)'ünde geç dönem takiplerinde koroner arter hastalığı ve allogreft vaskülopati gelişimi görüldü. Hastaların ikisi erkek, biri kadın olup yaşları 22, 24 ve 39 idi. Genç hastalarda multidamar hastalığı gelişmesi nedeniyle invazif işlem uygulandı. Kadın olan hasta tanı konulduktan bir yıl sonra kaybedildi. İki hastanın medikal takipleri devam etmektedir. Allogreft vaskülopatisi oldukça difüz seyreden, tedavisinde invazif işlemlerin başarısının sınırlı olduğu bir patolojidir

Keywords

Kardiyak allogreft vaskülopatisi tüm koroner arter boyunca fibröz intimal hiperplazinin gelişimiile karakterize koroner arter hastalığının hızlandırılmış bir formudur. Kalp transplantasyonundauzun dönem sağkalımda belirleyici majör bir f

References

• Taylor DO, Edwards LB, Aurora P, Christie JD, Dobbels F, Kirk R, et al. Registry of the international society for heart and lung trans- plantation: twenty-fifth official adult heart transplant-report 2008. J Heart Lung Transplant 2008;27:943-56.
• Billingham ME. Histopathology of graft coronary disease. J Heart Lung Transplant 1992;11(Suppl):S38-S44.
• Erdoğan HB, Göksedef D. Kalp transplantasyonu sonrası mortali- te ve sağkalım. Türkiye Klinikleri J Surg Med Sci 2006;2:76-81.
• Taylor DO, Stehlik J, Edwards LB, Aurora P, Christie JD, Dobbels F, et al. Registry of the international society for heart and lung- transplantation: twenty-sixth official adult heart transplant-report 2009. J Heart Lung Transplant 2009;28:1007-22.
• Mitchell RN. Graft vascular disease: immune response meets the vessel wall. Annu Rev Pathol 2009;4:19-47.
• Schoenhagen P, Nissen S. Understanding coronary artery dise- ase: tomographic imaging with intravascular ultrasound. Heart 2002;88:91-6.
• Spes CH, Mudra H, Schnaack SD, Klauss V, Reichle FM, Überfuhr P, et al. Dobutamine stress echocardiography for noninvasive di- agnosis of cardiac allograft vasculopathy: a comparison with angi- ography and intravascular ultrasound. Am J Cardiol 1996;78:168- 74.
• Wenke K, Meiser B, Thiery J, Nagel D, von Scheidt W, Krobot K, et al. Simvastatin initiated early after heart transplantation: 8-year prospective experience. Circulation 2003;107:93-7.
• Schroeder JS, Gao SZ, Alderman EL, Hunt SA, Johnstone I, Bo- othroyd DB, et al. A preliminary study of diltiazem in the prevention of coronary artery disease in heart-transplant recipients. N Engl J Med 1993;328:164-70.
• Bae JH, Rihal CS, Edwards BS, Kushwaha SS, Mathew V, Prasad A, et al. Association of angiotensin-converting enzyme inhibitors and serum lipids with plaque regression in cardiac allograft vascu- lopathy. Transplantation 2006;82:1108-11.
• Erinc K, Yamani MH, Starling RC, Crowe T, Hobbs R, Bott- Silverman C, et al. The effect of combined angiotensin-converting enzyme inhibition and calcium antagonism on allograft coronary vasculopathy validated by intravascular ultrasound. J Heart Lung Transplant 2005;24:1033-8.
• Segovia J, Gomez-Bueno M, Alonso-Pulpon L. Treatment of allog- raft vasculopathy in heart transplantation. Expert Opin Pharmacot- her 2006;7:2369-83.
• Kobashigawa JA, Patel J, Furukawa H, Moriguchi JD, Yeatman L, Takemoto S, et al. Five-year results of a randomized, single-center study of tacrolimus vs. microemulsion cyclosporine in heart trans- plant patients. J Heart Lung Transplant 2006;25:434-9.
• Kobashigawa JA, Tobis JM, Mentzer RM, Valantine HA, Bourge RC, Mehra MR, et al. Mycophenolate mofetil reduces intimal thick- ness by intravascular ultrasound after heart transplant: reanalysis of the multicenter trial. Am J Transplant 2006;6:993-7.
• Ficial effects of mycophenolate mofetil. J Heart Lung Transplant 2006;25:550-6.