Following a cardiac transplant, some individuals will develop a type of chronic rejection called coronary artery disease. This is different from the narrowed arteries often seen in individuals who have not had heart transplants. It can happen at any time after a heart transplant, but usually is seen a few years after the surgery. Another complication is called cardiac allograft vasculopathy (CAV). CAV makes the walls of the heart's arteries thick and hard making blood circulation more difficult. It can result in a heart attack, failure of the heart, cardiac death, or abnormal heart rhythms.
A Answers (3)
Piedmont Heart Institute answered
Nassir Azimi, MD, Cardiology, answered
There are two ways a person would get coronary disease after a transplant. Most often, it is immune mediated and progressive arterial narrowing as part of the global immune reaction to a transplanted heart.
Additionally, should a transplanted patient live long enough, natural progressive atherosclerosis can also play a role.
Yes, you can get coronary artery disease after a heart transplant. In fact, it is not uncommon beyond the first couple years after transplant and the risk increases the longer you live. It is referred to as Coronary Allograft Vasculopathy (CAV) and can be different than traditional coronary artery disease. Rather than discrete plaque formation, there may be diffuse disease throughout the coronary arteries. Typically it progresses slowly. However, some patients have a very rapid progression of the disease. CAV is a complex disease that is thought to be in part an immune mediated response to chronic rejection. Patients can have no symptoms or symptoms of heart failure (shortness of breath, fatigue, fluid retention, decreased activity tolerance). Treatments may include changes to immunosuppressant medications and/or stent placement if necessary. Patients with rapidly progressing, severe disease may undergo re-transplant. Heart transplant recipients undergo regular evaluation of their coronary arteries to screen for CAV. The test used and timing between testing is determined by the transplant specialist based on the patient’s history, the length of time since transplant, and the course of CAV if present.