Heart Transplantation Allograft Vasculopathy

There are 5.1 million patients with chronic heart failure in the United States, and heart failure is the leading cause of hospitalization among adults greater than 65 years of age. With more than 1 million patients being hospitalized for the primary diagnosis of heart failure, Medicare spending exceeds $17 billion per annum on this diagnosis. Despite advances in mechanical circulatory support, cardiac transplant remains the definitive treatment intervention for patients with advanced heart failure and refractory symptoms who cannot be managed with optimal medical therapy.Since the first human heart transplant by Dr. Christiaan Barnard in 1967, a slew of disruptive innovations and multidisciplinary efforts have sophisticated the field. At present, over 5,000 heart transplants are carried out worldwide every year. Despite the encouraging numbers, obstacles still exist.Cardiac allograft vasculopathy (CAV) is a recognized long-term complication seen post-cardiac transplant. Considered a chronic fibroproliferative rejection to the transplanted heart, it is amongst the top three causes of death after the first year of transplantation. The prevalence of CAV in patients post-cardiac transplant at 1, 5, and 10 years was 8%, 29%, and 47%, respectively as described by the 2019 International Society for Heart and Lung Transplantation (ISHLT) registry data report.