Cardiac Allograft Vasculopathy in Transplant Recipients

Cardiac allograft vasculopathy (CAV) is a diffuse, concentric narrowing of coronary arteries that emerges as a major cause of late graft failure in heart transplant recipients. Unlike typical atherosclerosis, CAV affects both epicardial and intramyocardial vessels, often without anginal symptoms due to denervation of the graft. Immune-mediated injury, chronic low-grade inflammation and endothelial dysfunction combine with traditional cardiovascular risk factors to drive progressive intimal hyperplasia and fibrosis. Early detection is challenging, as routine angiography has limited sensitivity for diffuse changes and non-invasive tests vary in accuracy. Surveillance strategies now integrate advanced imaging modalities and biomarkers to detect subclinical disease. Management focuses on optimisation of immunosuppression, lipid-lowering therapy and blood pressure control, alongside percutaneous interventions in selected focal lesions. Despite these measures, CAV remains the principal barrier to long-term survival after heart transplantation, underscoring the need for improved mechanistic understanding and novel therapies to preserve graft vasculature and enhance patient outcomes worldwide.

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Cardiac Allograft Vasculopathy in Transplant Recipients publication trend

The graph below shows the total number of articles in cardiac allograft vasculopathy in transplant recipients across all publications each year (not limited to Nature Index journals).

Technical terms

Cardiac allograft vasculopathy (CAV): Obliterative concentric intimal hyperplasia affecting coronary arteries in transplanted hearts, characterised by diffuse vessel narrowing driven by immune- and non-immune-mediated mechanisms.

Coronary computed tomography angiography (CCTA): Non-invasive imaging technique using contrast-enhanced CT to visualise coronary artery anatomy, plaque characteristics and perivascular tissue properties.

Pericoronary adipose tissue density (PCAT density): Quantitative CT measure of fat attenuation surrounding coronary arteries, reflecting local inflammatory activity and vascular injury.

Hedgehog signalling pathway: Conserved cellular communication cascade involved in development and tissue repair, whose aberrant activation can promote vascular inflammation and remodelling.

Intravascular ultrasound (IVUS): Catheter-based ultrasound modality that provides cross-sectional images of vessel walls to detect intimal thickening and quantify plaque burden.

Optical coherence tomography (OCT): High-resolution intravascular imaging using near-infrared light to assess microstructural details of coronary lesions and plaque morphology.

References

1. Hedgehog signalling in allograft vasculopathy: a new therapeutic target?. Trends in Pharmacological Sciences (2023).
2. Computed tomography pericoronary adipose tissue density predicts coronary allograft vasculopathy and adverse clinical outcomes after cardiac transplantation. European Heart Journal - Cardiovascular Imaging (2024).
3. Invasive Coronary Imaging Assessment for Cardiac Allograft Vasculopathy: State-of-the-Art Review. Journal of the Society for Cardiovascular Angiography & Interventions (2022).