Section 69
Chapter 68,043

Coronary Artery Vasculopathy in Pediatric Cardiac Transplant Patients

DrBiagio A.Pietra, M.M.B.

Pediatric Drugs 5(8): 513-524


ISSN/ISBN: 1174-5878
DOI: 10.2165/00148581-200305080-00002
Accession: 068042512

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The single largest cause of late graft loss in pediatric cardiac transplantation is transplant coronary artery vasculopathy (CAV). The mechanism of CAV remains unknown; it appears to have both immune and non-immune causes. The final common pathway of these mechanisms is endothelial activation, a prothrombotic environment, and endothelial damage with subsequent diffuse intimal proliferation. The disease process has largely been thought to be progressive and unresponsive to treatment. Re-transplantation has been advocated as the only definitive treatment. The appropriate management is largely unknown; intervention or surgical management has had limited utility, while medical management appears to have the most promise. Improvement in outcome can be achieved by optimizing non-immune factors and aggressive management of the immune mechanisms. Long-term survival of transplant patients after diagnosis with CAV is now being reported.

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