Cardiac allograft endothelial dysfunction

Cardiac allograft endothelial dysfunction precedes structural coronary alterations after heart transplantation. The etiology of allograft endothelial dysfunction includes alloimmune-dependent and alloimmune-independent activation of immune cells, cytokines, growth factors, and extracellular matrix proteases. Cytomegalovirus infection of the endothelium promotes processes that favor atherogenesis and vascular lesion formation. The impaired bioactivity of the endothelium-derived nitric oxide triggers vasomotor dysfunction, leukocyte and platelet adhesion, apoptosis, and smooth muscle cell growth. Coronary endothelial dysfunction in the cardiac allograft has a prognostic impact that is independent of structural coronary changes.