Cardiac allograft vasculopathy: current concepts, recent developments, and future directions.

Survival after heart transplantation has improved steadily over the past decade, with 1-year mortality rates now less than 15% in most centers. Despite a substantial improvement in early survival, late death has not been significantly impacted. The major cause of late death is due to cardiac allograft vasculopathy, an accelerated form of coronary artery disease. The mechanisms responsible for cardiac allograft vasculopathy are thought to be immunologic; however direct confirmation of this is lacking. Because cardiac allograft vasculopathy is not amenable to traditional therapies for coronary atherosclerosis, to date the only treatment is repeat transplantation. This paper reviews the clinical aspects of cardiac allograft vasculopathy, the recent experimental work, and potential future directions for study.