Coronary Microvasculopathy After Heart Transplantation A New Marker to Guide Future Trials?

Aunique form of coronary artery disease remains themajor limitation to long-term survival in heart transplant recipients, playing a major role in the current half-life of the graft of 10 years. Our understanding of the pathogenesis of cardiac transplantation coronary artery disease (TCAD) has evolved from the initial paradigm that it was due entirely to the host immune response or an antigen-dependent process. This belief was based on observations such as circumferential involvement of the allograft vessels throughout their length, the limitation of this process to the allograft vascular bed, and its appearance in recipients of all ages, including adolescents. However, unlike with kidney transplantations, the expected correlation between the number of HLA antigens matched between donor and recipient and the number or severity of rejection episodes and the development of TCAD has not been very consistent.