CARDIAC GRAFT VASCULOPATHY - ETIOLOGIC FACTORS AND THERAPEUTIC APPROACHES

Heart transplantation has become an accepted and successful treatment for end-stage heart disease with survival rates of 80-90% after one ye ar and 70% after 5 years. During the early posttransplant period (6-12 months), patients are subject to two major complications: rejection a nd infection. Fortunately, a certain degree of graft tolerance develop s, allowing the immunosuppressive therapy to be progressively tapered off with a concomitant decrease in infectious problems. Long-term surv ival, however, is largely dependent on the development of an accelerat ed atherosclerosis in the graft, which is believed to represent some k ind of chronic rejection. This transplant vasculopathy is documented b y means of coronary angiography with an incidence of approximately 5 t o 10% per year. It is not surprising therefore that major interest has risen concerning risk factors promoting this pathology.