Accelerated coronary artery disease after heart transplant is a problem that occurs several years after heart transplant. The body's immune system treats the transplanted heart like a foreign body and essentially slowly attacks the transplanted organ, and the coronary arteries of the transplanted heart become progressively scarred and fibrosed and develop narrowing and severe blockages that are typically more extensive and more difficult to treat than atherosclerotic coronary artery disease. The process occurs over a period of a few years and typically around 5 years is when symptoms and signs begin to develop that require some kind of intervention. There are not many good ways at preventing the process. Good immunosuppression after transplant, the use of statin medications, aspirin, anti-oxidants and calcium channel blockers may help to delay the process.
A Answers (4)
Sameer A. Sayeed, MD, Cardiology, answered
Accelerated coronary artery disease in the transplanted heart is poorly understood. It is the development of blockages in the arteries of the new heart. The blockages can be localized and treatable with coronary angioplasty or stents, or, more often, are diffuse, occurring throughout the length of the coronary arteries. The mechanism of this complication is felt to be chronic autoimmune inflammation within the arteries. Because the transplanted heart is denervated, there may not be the sensation of angina before heart damage occurs. The blockages can be treated with medications, sometimes with angioplasty or stenting, or, in the worse cases may require retransplantation.
Joane Goodroe, Nursing, answeredAccelerated coronary artery disease after a heart transplant is different than the typical coronary artery disease. In a heart transplant patient, the disease can be diffuse throughout the coronary arteries so these patients are not usually candidates for coronary bypass surgery. There is a great deal of research to pinpoint the cause of this process which occurs in some heart transplant patients. Some theories suggest is may be associated with an immune response from antibodies that the body forms from the transplanted heart.
James Januzzi, Cardiology, answeredWhile heart transplantation has given a new life to patients with end stage heart disease, it does come with significant down-sides, one of which is the accelerated coronary artery disease that we occasionally see in transplant recipients. Known as coronary allograft vasculopathy, such accelerated disease manifests as diffuse narrowing of the arteries in the transplanted heart, and may lead to heart attacks and graft failure. Numerous reasons exist as to why allograft vasculopathy forms, but at present there are no specific therapies that either well-prevent it or treat it once it develops.