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Circulation, Vol 76, 827-834, Copyright © 1987 by American Heart Association
BF Uretsky, S Murali, PS Reddy, B Rabin, A Lee, BP Griffith, RL Hardesty, A Trento and HT Bahnson
Coronary artery disease (CAD) has been shown in previous uncontrolled
studies to be a limiting factor to long-term survival in patients
undergoing cardiac transplantation and who were taking conventional
immunosuppressive agents. To study the development of CAD after cardiac
transplantation in patients taking the newer immunosuppressive agent
cyclosporine, we prospectively performed yearly coronary arteriography on
all eligible transplantation patients (first year, 57 patients; second
year, 30 patients; third year, 14 patients). The prevalence of CAD by life
table analysis was 18% at 1 year, 27% at 2 years, and 44% at 3 years. The
occurrence of two or more major rejection episodes was associated (p less
than .005) with the development of CAD. In two patients who died of CAD,
coronary artery histology revealed subintimal inflammatory cellular
infiltration in some lesions. These data demonstrate that the prevalence of
CAD rises progressively over time and immunologic factors may be important
in its development.
ARTICLES
Development of coronary artery disease in cardiac transplant patients receiving immunosuppressive therapy with cyclosporine and prednisone
Department of Medicine, Presbyterian University Hospital, Pittsburgh, PA 15213.
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