Cardiac transplantation chronic rejection

More specifically in heart transplant recipients, bleeding, leaks, and frank rupture can occur at the anastomosis sites the most critical of which is the aortic anastomosis, particularly if there is a marked difference in diameter between the donor and recipient aorta (Knisely et al. 1999 Reitz et al. 1982) (Fig. 2.2.3). In addition, acute or chronic breakdown at the aortic anastomosis can lead to aortic dehiscence, dissection, and pseudoaneurysm formation (Henry et al. 1989 Knollmann et al. 2000a Knosalla et al. 1996). Pseudoaneurysms can also form at two additional sites in the cardiac transplant patient at the cannulation sites used for cardiopulmonary bypass and at the endomyocardial biopsy sites in the right ventricle, taken to look for rejection (Knisely et al. 1999). Although most of these complications occur in the immediate post-operative period, some can occur months to years later (Knisely et al. 1999). Aortic dissection, when it occurs in the heart transplant patient (l%-2%), usually involves the recipient s native aorta, although rare cases of dissection involving the donor s aorta have been reported (ScHELLEMANS et al. 2004). Dissection can occur in the immediate peri-operative period usually due to mismatches in donor-recipient vessel size or years later when they may he due to infection or accelerated atherosclerosis (Schellemans et al. 2004). 

Vasculopathy of the coronary arteries in the donor heart that is accelerated and progressive is a mark of chronic rejection, and continues to be a significant obstacle to long-term survival of cardiac transplant recipients (Knollmann et al. 2000a Massad 2004 Taylor et al. 2004). Half of all patients who are 5 years out from cardiac transplantation dem-... 

Utans, U., Liang, P., Wyner, L. R., Karnovsky, M. J., and Russell, M. E. (1994) Chronic cardiac rejection identification of five upregulated genes in transplanted hearts by differential mRNA display. PNAS 91, 6463-6467... 

---