Purpose of review: Cardiac allograft vasculopathy (CAV) is a unique form of accelerated atherosclerosis occurring in heart transplant recipients and this complication has a major negative impact on long-term survival. An understanding of recent advances in the understanding of CAV pathogenesis, accurate diagnosis and effective treatment is important given the increasing number of heart transplant procedures being performed annually.
Recent findings: This review article will discuss the complex immunological and nonimmunological processes that are likely to contribute to endothelial activation and the chronic inflammatory response causing intimal hyperplasia that is characteristic of CAV. Accurate diagnosis of CAV is essential, and both current and emerging imaging modalities will be reviewed. Finally, current treatment of CAV, together with future therapeutic strategies, will be discussed.
Summary: CAV is an important complication-limiting survival after heart transplant, and a clear understanding of the underlying pathophysiological processes is important. The diagnosis of CAV can be difficult, but it is possible with the appropriate imaging modalities. Effective treatment of CAV remains an important clinical challenge, and current immunosuppressive therapy has limited efficacy. However, newer immunosuppressive agents have demonstrated promising results in clinical trials, and this will hopefully allow more effective disease management in the near future.