Mechanisms of chronic cardiac allograft rejection

John P. Costello, Thalachallour Mohanakumar, Dilip S. Nath

Research output: Contribution to journalReview articlepeer-review

70 Scopus citations


Chronic rejection in the form of cardiac allograft vasculopathy is one of the major factors that affects long-term graft and patient survival after heart transplantation. Whereas multiple factors contribute to the development of cardiac allograft vasculopathy, immunologic mechanisms play the predominant role in the chronic rejection process, because both alloimmune and autoimmune responses are causal factors. In addition, many nonimmune donor and recipient factors also affect the development of cardiac allograft vasculopathy, including hyperlipidemia, cytomegalovirus infection, baseline coronary artery disease, and the mechanism of brain death in the donor. Modern immunosuppression maintenance therapies have the potential to limit the development of cardiac allograft vasculopathy in the long term. Further research initiatives are needed to identify patient-specific immunosuppressive drug regimens and to elucidate factors that contribute to the chronic rejection of cardiac transplant allografts.

Original languageEnglish
Pages (from-to)395-399
Number of pages5
JournalTexas Heart Institute journal
Issue number4
StatePublished - Oct 8 2013


  • Alloimmunity
  • Arteriosclerosis/etiology
  • Autoimmunity
  • Brain death
  • Graft rejection, chronic/immunology/prevention and control
  • Heart transplantation
  • Immunity, cellular
  • Immunology/mortality/trends
  • Vasculopathy/cardiac allograft/cardiac transplant


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