Pathologic markers of allograft arteriopathy: insight into the pathophysiology of cardiac allograft chronic rejection

Transplant-associated coronary artery disease (CAD) is the principal limiti ng factor for the long-term survival of heart trans plant patients. This re view discusses early risk factors for the subsequent development of transpl ant-associated CAD. Early risk factors associated with a prothrombogenic mi crovasculature, such as deposition of microvascular fibrin, depletion of va scular tissue plasminogen activator, presence of endothelial activation of the allograft arterial tree, and loss of vascular antithrombin, as well as changes in circulation (ie, detectable serum cardiac troponin I and elevate d serum soluble intercellular adhesion molecule-1 levels) are presented and discussed. New therapies that could improve the status of the allograft mi crovasculature and may prevent or mitigate the development of transplant-as sociated CAD are considered. Curr Opin Cardiol 2001, 16:110-117 (C) 2001 Li ppincott Williams & Wilkins, Inc.