Can my new transplanted heart develop blockages? What is cardiac allograph vasculopathy?

Although acute rejection of your new heart is rare after the first 6 months, the body may continue to attack the new heart. Narrowing in the coronary arteries (or blockages) of your transplanted heart can occur after a transplant and is sometimes called chronic rejection.

This chronic rejection is called cardiac allograph vasculopathy, which means literally “heart transplant blood vessel abnormality.” It can occur anytime after a transplant but is not typically seen until several years after transplantation.

This type of coronary artery disease is different from the commonly seen fatty cholesterol plaques that occur in nontransplanted hearts with atherosclerosis (the kind you may have experienced before your transplant). Transplant allograph vasculopathy is mediated by the immune system. It causes a diffuse, smooth, widespread narrowing of all the coronary arteries. Unlike coronary arteries with atherosclerosis, cardiac allograph vasculopathy cannot be fixed by balloon angioplasty or coronary artery stenting.

To monitor for this condition, you undergo a cardiac catheterization and coronary angiogram at your first year anniversary. This is compared with a noninvasive imaging stress test of your heart (either ultrasound or nuclear medicine). Thereafter a noninvasive imaging stress test is performed annually. If these tests show any abnormality, a follow-up coronary angiogram may be arranged.

Treatment of posttransplant vasculopathy is very difficult, so prevention is the key. After a transplant you must follow a heart-healthy lifestyle and take medicines to help lessen the risk of vasculopathy and future coronary artery disease. Keeping both your cholesterol and blood pressure under tight control is especially important.