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Diagnosis and Management of Cardiac Allograft Vasculopathy (Chronic Rejection)

  • L. W. Miller
  • T. Donahue
  • T. Wolford
  • J. Drury

Abstract

The greatest impediment to long-term survival for adult and pediatric heart transplant recipients is the development of an accelerated form of coronary artery disease[1]–[4]. This is variously termed chronic allograft vasculopathy, chronic allograft coronary artery disease, or chronic rejection. This disease was reported in the original preclinical animal experiments, and subsequently in the early human heart transplant recipients at Stanford, USA 6.7 and Cape Town, South Africa”. The incidence of this disease has been estimated at 10% per year post-transplant[4],[9]’[11]. Although cyclosporin has been associated with an improvement in 1- and 5-year graft survival, as well as a decrease in death due to rejection, it has not had an impact on reducing the incidence of allograft coronary artery disease (ACAD)[12]’[15] in adults, but increased immunosuppression may decrease the incidence in pediatric patients[15].

Keywords

Heart Transplant Coronary Flow Reserve Cardiac Transplantation Chronic Rejection Cardiac Allograft 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Walley V, Masters R, Boone S et al. Analysis of deaths after heart transplantation: the University of Ottawa Heart Institute experience. J Heart Lung Transplant. 1993; 12:790–81.PubMedGoogle Scholar
  2. 2.
    Carrier M, Pelletier G, Leclerc Y et al. Accelerated coronary atherosclerosis after cardiac transplantation: major threat to long-term survival. Can J Surg. 1991;34:133–6.PubMedGoogle Scholar
  3. 3.
    Pahl E, Fricker F, Armitage J et al. Coronary arteriosclerosis in pediatric heart transplant survivors: limitation of long-term survival. J Pediatr. 1990;116:177–83.PubMedCrossRefGoogle Scholar
  4. 4.
    Schroeder J, Gao S, Hunt S et al. Accelerated graft coronary artery disease: diagnosis and prevention. J Heart Lung Transplant. 1992;11:S258–66.PubMedGoogle Scholar
  5. 5.
    Kosek J, Hurley E, Lower R. Histopathology of orthotopic canine cardiac homografts. Lab Invest. 1968;19:97–111.PubMedGoogle Scholar
  6. 6.
    Kosek JC, Hurley EJ, Lower RR. Heart graft arteriosclerosis. Transplant Proc. 1971;3:512–14.PubMedGoogle Scholar
  7. 7.
    Bieber CP, Stinson EB, Shumway NE et al. Cardiac transplantation in man. VII. Cardiac allograft pathology. Circulation. 1970;41:753–72.PubMedGoogle Scholar
  8. 8.
    Thomson JG. Production of severe atheroma in a transplanted human heart. Lancet. 1969;2(630):1088–91.PubMedCrossRefGoogle Scholar
  9. 9.
    Pennock J, Over P, Reitz B et al. Cardiac transplantation in perspective for the future. Survival, complications, rehabilitation, and cost. J Thorac Cardiovasc Surg. 1982;83:168–77.PubMedGoogle Scholar
  10. 10.
    Pascoe E, Barnhart G, Carter W et al. The prevalence of cardiac allograft arteriosclerosis. Transplantation. 1987;44:838.PubMedCrossRefGoogle Scholar
  11. 11.
    Young J. Cardiac allograft arteriopathy: an ischemic burden of a different sort. Am J Cardiol. 1992;70:9F–13F.PubMedCrossRefGoogle Scholar
  12. 12.
    Uretsky B, Murali S, Reddy P et al. Development of coronary artery disease in cardiac transplant patients receiving immunosuppressive therapy with cyclosporin and prednisone. Circulation. 1987;76:827–34.PubMedGoogle Scholar
  13. 13.
    Gao S, Schroeder J, Alderman E et al. Prevalence of accelerated coronary artery disease in heart transplant survivors. Comparison of cyclosporin and azathioprine regimens. Circulation. 1989;89(Suppl. III):III–100.Google Scholar
  14. 14.
    Olivari M, Homans D, Wilson R et al. Coronary artery disease in cardiac transplant patients receiving triple-drug immunosuppressive therapy. Circulation. 1989;80:III–111.Google Scholar
  15. 15.
    Addonizio L, Hsu D, Douglas J et al. Decreasing incidence of coronary disease in pediatric cardiac transplant recipients using increased immunosuppression. Circulation. 1993;88:224–9.Google Scholar
  16. 16.
    Gao S, Hunt S, Schroeder J et al. Does rapidity of development of transplant coronary artery disease portend a worse prognosis? J Heart Lung Transplant. 1994;13:1119–24.PubMedGoogle Scholar
  17. 17.
    Keogh A, Valuntine H, Hunt S et al. Impact of proximal or midvessel discrete coronary artery stenoses on survival after heart transplantation. J Heart Lung Transplant. 1992:11:892–901.PubMedGoogle Scholar
  18. 18.
    Park J, Hsu D, Hordof A et al. Arrhythmias in pediatric heart transplant recipients: prevalence and association with death, coronary artery disease, and rejection. J Heart Lung Transplant. 1993;12:956–64.PubMedGoogle Scholar
  19. 19.
    Gao S, Schroeder J, Hunt S et al. Acute myocardial infarction in cardiac transplant recipients. Am J Cardiol. 1989;64:1093–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Wilson R, Christenson B, Olivari M et al. Evidence for structural sympathetic reinnervation after orthotopic cardiac transplantation in humans. Circulation. 1991;83:1210–20.PubMedGoogle Scholar
  21. 21.
    Wharton J, Polak J, Gordon L et al. Immunohistochemical demonstration of human cardiac innervation before and after transplantation. Circ Res. 1990;66:900–12.PubMedGoogle Scholar
  22. 22.
    Stark R, McGinn A, Wilson R. Chest pain in cardiac transplant recipients. Evidence of sensory reinnervation after cardiac transplantation. N Engl J Med. 1991;324:1791–807.PubMedGoogle Scholar
  23. 23.
    Miller L. Long-term complications of cardiac transplantation. Prog Cardiovasc Dis. 1991;33:242–8.CrossRefGoogle Scholar
  24. 24.
    Cramer D. Transplant arteriosclerosis. Transplant Sci. 1991;1:60–3.Google Scholar
  25. 25.
    Fyfe A. Transplant atherosclerosis: the clinical syndrome, pathogenesis, and possible model of spontaneous atherosclerosis. Can J Cardiol. 1992;8:509–19.PubMedGoogle Scholar
  26. 26.
    Barnhart G, Pascoe E, Mills A et al. Accelerated coronary arteriosclerosis in cardiac transplant recipients. Transplant Rev. 1987;1:31–46.Google Scholar
  27. 27.
    Ewel C, Foegh M. Chronic graft rejection: accelerated transplant arteriosclerosis. Immunol Rev. 1993;134:21–31.PubMedCrossRefGoogle Scholar
  28. 28.
    Hosenpud J, Shipley G, Wagner C. Cardiac allograft vasculopathy: current concepts, recent developments, and future directions. J Heart Lung Transplant. 1992;11:9–23.PubMedGoogle Scholar
  29. 29.
    Hosenpud J. Immune mechanisms of cardiac allograft vasculopathy: an update. Transplant Immunol. 1993;1:237–49.CrossRefGoogle Scholar
  30. 30.
    Lurie KG, Billingham ME, Jamieson SW et al. Pathogenesis and prevention of graft arteriosclerosis in an experimental heart transplant model. Transplantation. 1981;31:41–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Minick CR, Alonso DR, Rankin L. Role of immunologic arterial injury in at herogenesis. Thromb Haemost. 1978;29:304–11.Google Scholar
  32. 32.
    Cramer D, Chapman F, Wu G et al. Cardiac transplantation in the rat. II. Alteration of the severity of donor graft arteriosclerosis by modulation of the host immune response. Transplantation. 1990;50:554–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Cramer D, Qian S. Harnaha J et al. Cardiac transplantation in the rat. I. The effect of histocompatibility differences on graft arteriosclerosis. Transplantation. 1989;47:414–19.PubMedCrossRefGoogle Scholar
  34. 34.
    Hosenpud J, Everett J, Morris T et al. Cellular and humoral immunity to vascular endothelium and the development of cardiac allograft vasculopathy. J Heart Lung Transplant (In press).Google Scholar
  35. 35.
    Libby P, Salomon R, Payne D et al. Functions of vascular wall cells related to development of transplantation-associated coronary arteriosclerosis. Transplant Proc. 1989;21:3677–84.PubMedGoogle Scholar
  36. 36.
    Gravanis M. Allograft heart accelerated atherosclerosis: evidence for cell-mediated immunity in pathogenesis. Mod. Pathol. 1989;2:495–505.PubMedGoogle Scholar
  37. 37.
    Rose M, Dunn M. What causes accelerated coronary artery disease after cardiac transplantation? Primary Cardiol. 1993;19:34–9.Google Scholar
  38. 38.
    Almond P, Matas A, Gillingham K et al. Risk factors for chronic rejection in renal allograft recipients. Transplantation. 1993;55:752–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Basadonna G, Malas A, Gillingham K et al. Early versus late acute renal allograft rejection: impact on chronic rejection. Transplantation. 1993;55:993–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Heeman U, Azuma H, Tullius S et al. The contribution of reduced functioning mass to chronic kidney allograft dysfunction in rats. Transplantation. 1994;58:1317–22.Google Scholar
  41. 41.
    Stovin P, Sharples L, Schofield P et al. Lack of association between endomyocardial evidence of rejection in the first six months and the later development of transplant-related coronary artery disease. J Heart Lung Transplant. 1993;12:110–16.PubMedGoogle Scholar
  42. 42.
    Costanzo-Nordin M. Cardiac allograft vasculopathy: relationship with acute cellular rejection and histocompatibility. J Heart Lung Transplant. 1992;11:S90–103.Google Scholar
  43. 43.
    Zerbe T, Uretsky B, Kormos R et al. Graft atherosclerosis: effects of cellular rejection and human lymphocyte antigen. J Heart Lung Transplant. 1992;11:S104–10.Google Scholar
  44. 44.
    Gao S, Schroeder J, Hunt S et al. Influence of graft rejection on incidence of accelerated graft coronary artery disease: a new approach to analysis. J Heart Lung Transplant. 1993;12:1029–35.PubMedGoogle Scholar
  45. 45.
    Schutz A, Kemkes R, Kugler C et al. The influence of rejection episodes on the development of coronary artery disease after heart transplantation. Eur J Cardiothorac Surg. 1990;4:300–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Winters GL, Loh E, Schoen FJ. Natural history of focal moderate cardiac allograft rejection. Is treatment warranted? Circulation. 1995;91:1975–80.PubMedGoogle Scholar
  47. 47.
    Fishbein M, Bell G, Lones M et al. Grade 2 cellular heart rejection: does it exist? J Heart Lung Transplant. 1994; 13:1051–7.PubMedGoogle Scholar
  48. 48.
    Yeoh T, Frist W, Eastbum T et al. Clinical significance of mild rejection of the cardiac allograft. Circulation. 1992;86:II–267–71.Google Scholar
  49. 49.
    Kobashigawa JA. Does acute rejection correlate with the development of transplant coronary artery disease? A multi-center study using intravascular ultrasound. Presented to the International Society for Heart and Lung Transplantation meeting, 1995. (In press).Google Scholar
  50. 50.
    Hammond E, Ensley R, Yowell R et al. Vascular rejection of human cardiac allografts and the role of humoral immunity in chronic allograft rejection. Transplant Proc. 1991;23:26–30.PubMedGoogle Scholar
  51. 51.
    Hess M, Hastillo A, Mohanakumar T et al. Accelerated atherosclerosis in cardiac transplantation: role of cytotoxic B cell antibodies and hyperlipidemia. Circulation. 1983;68:II–94.Google Scholar
  52. 52.
    Rose E, Pepino P, Barr M et al. Relation of HLA antibodies and graft atherosclerosis in human cardiac allograft recipients. J Heart Lung Transplant. 1992;11:S120–3.PubMedGoogle Scholar
  53. 53.
    Rose E, Smith C, Petrossian G et al. Humoral immune responses after cardiac transplantation: correlation with fatal rejection and graft atherosclerosis. Surgery. 1989:106:203–8.PubMedGoogle Scholar
  54. 54.
    Fenoglio J, Ho E, Reed E et al. Anti-HLA antibodies and heart allograft survival. Transplant Proc. 1989;21;807–9.PubMedGoogle Scholar
  55. 55.
    Petrossian G, Nichols A, Marboe C et al. Relation between survival and development of coronary artery disease and anti-HLA antibodies after cardiac transplantation. Circulation. 1989:80:III–122.Google Scholar
  56. 56.
    Rose M. Antibody-mediated rejection following cardiac transplantation. Transplant Rev. 1993;7:140–52.CrossRefGoogle Scholar
  57. 57.
    Dunn M, Crisp S, Rose M et al. Anti-endothelial antibodies and coronary artery disease after cardiac transplantation. Lancet. 1992;339:1566–70.PubMedCrossRefGoogle Scholar
  58. 58.
    Crisp S, Dunn M, Rose M et al. Antiendothelial antibodies after heart transplantation: the accelerating factor in transplant-associated coronary artery disease? J Heart Lung Transplant. 1994;13:81–92.PubMedGoogle Scholar
  59. 59.
    Wheeler C, Collins A, Dunn M et al. Characterization of endothelial antigens associated with transplant associated coronary artery disease. J Heart Lung Transplant. (In press).Google Scholar
  60. 60.
    Stinson EB, Payne R, Griepp RB et al. Correlation of histocompatibility matching with graft rejection and survival after cardiac transplantation in man. Lancet 1971;2(722):459–61.PubMedCrossRefGoogle Scholar
  61. 61.
    Frist W, Oyer P, Baldwin J et al. HLA compatibility and cardiac transplant recipient survival. Ann Thorac Surg. 1987;44:242–6.PubMedGoogle Scholar
  62. 62.
    Smith J, Pomerance A, Burke M et al. Effect of HLA matching on graft function and long term survival after cardiac transplantation. Results of a large single center study. J Heart Lung Transplant. 1995;14:S40.Google Scholar
  63. 63.
    Costanzo MR. The role of histoincompatibility in cardiac allograft vasculopathy. J Heart Lung Transplant. (In press).Google Scholar
  64. 64.
    Costanzo-Nordin M. Cardiac allograft vasculopathy: relationship with acute cellular rejection and histocompatibility. J Heart Lung Transplant 1992;11:S90–103.Google Scholar
  65. 65.
    Cocanougher B, Ballantyne C, Pollack M et al. Degree of HLA mismatch as a predictor of death from allograft arteriopathy after heart transplant. Transplant Proc. 1993;25:233–6.PubMedGoogle Scholar
  66. 66.
    Johnson M. Transplant coronary disease: nonimmunologic risk factors. J Heart Lung Transplant. 1992;11:S124–32.Google Scholar
  67. 67.
    Gao S, Hunt S, Alderman E et al. Relationship of donor age and preexisting coronary disease by angiography and intracoronary ultrasound to later development of cardiac allograft coronary artery disease. J Heart Lung Transplant. 1995;14:S40.Google Scholar
  68. 68.
    Schuler S, Matschke K, Loebe M et al. Coronary artery disease in patients with hearts from older donors: morphologic features and therapeutic implications. J Heart Lung Transplant. 1993;12:100–9.PubMedGoogle Scholar
  69. 69.
    Winters GL, Kendall TJ, Radio SJ et al. Posttransplant obesity and hyperlipidemia: major predictors of seventy of coronary arteriopathy in failed human heart allografts. J Heart Transplant. 1990;9:364–71.PubMedGoogle Scholar
  70. 70.
    Gao S, Schroeder J. Alderman E et al. Clinical and laboratory correlates of accelerated coronary artery disease in the cardiac transplant patient. Circulation. 1987;76:V–56–61.Google Scholar
  71. 71.
    Valantine H. Role of lipids in allograft vascular disease: a multi-center study of intimal thickening detected by intravascular ultrasound. J Heart Lung Transplant. 1996;14:5234–7.Google Scholar
  72. 72.
    Alonso DR, Starek PK, Minick CR. Studies on the pathogenesis of atheroarteriosclerosis induced in rabbit cardiac allografts by the synergy of graft rejection and hypercholesterolemia. Am J Pathol. 1977;87:415–42.PubMedGoogle Scholar
  73. 73.
    Mennander A, Tikkanen M, Raisanen-Sokolowski A et al. Chronic rejection in rat aortic allografts. IV. Effect of hypercholesterolemia in allograft arteriosclerosis. J Heart Lung Transplant. 1993;12:123–32.PubMedGoogle Scholar
  74. 74.
    Hajjar D, Fabricant C, Minick C et al. Virus-induced atherosclerosis. Herpesvirus infection alters aortic cholesterol metabolism and accumulation. Am J Pathol. 1986;122:62–70.PubMedGoogle Scholar
  75. 75.
    Virella G, Lopes-Virella M. Infections and atherosclerosis. Transplant Proc. 1987;19:26–35.PubMedGoogle Scholar
  76. 76.
    Melnick J, Debakey M. Cytomegalovirus and atherosclerosis. Eur Heart J. 1993;14:30–8.PubMedGoogle Scholar
  77. 77.
    Kendall T, Wilson J, Radio S et al. Cytomegalovirus and other herpesviruses: do they have a role in the development of accelerated coronary arterial disease in human heart allografts? J Heart Lung Transplant. 1992;11:S14–20.PubMedGoogle Scholar
  78. 78.
    Grattan M, Moreno-Cabral C, Starnes V et al. Cytomegalovirus infection is associated with cardiac allograft rejection and atherosclerosis. J Am Med Assoc. 1989;261:3561–6.CrossRefGoogle Scholar
  79. 79.
    Fay L. Cytomegalovirus and coronary artery disease in heart transplant patients-accelerated low density lipoprotein and lipoprotein(A) modification as a proposed factor. J Heart Lung Transplant. 1994;12:155.Google Scholar
  80. 80.
    Koskinen P, Nieminen M, Krogerus L et al. Cytomegalovirus infection and accelerated cardiac allograft vasculopathy in human cardiac allografts. J Heart Lung Transplant. 1993;12:724–9.PubMedGoogle Scholar
  81. 81.
    Everett J, Hershberger R, Norman D et al. Prolonged cytomegalovirus infection is associated with development of acute cardiac allograft vasculopathy. J Heart Lung Transplant. 1992;11:S133–7.Google Scholar
  82. 82.
    McDonald K, Rector T, Braunlin E et al. Association of coronary artery disease in cardiac transplant recipients with cytomegalovirus infection. Am J Cardiol. 1989;64:359–62.PubMedCrossRefGoogle Scholar
  83. 83.
    Hendry PJ, Walley VM, Koshal A et al. Are temperatures attained by donor hearts during transport too cold? J Thorac Cardiovasc Surg. 1989;98:517–22.PubMedGoogle Scholar
  84. 84.
    Gaudin P, Rayburn B, Hutchins G et al. Peritransplant injury to the myocardium associated with the development of accelerated arteriosclerosis in heart transplant recipients. Am J Surg Pathol. 1994;18:338–46.PubMedGoogle Scholar
  85. 85.
    Day J, Hutchins G, Byrne B et al. Accelerated arteriosclerosis in heart transplant recipients: the central pathogenetic role of endothelial cell injury. J Heart Lung Transplant. (In press).Google Scholar
  86. 86.
    Land W, Schneeberger H, Schleibner S et al. The beneficial effect of human recombinant superoxide dismutase on acute and chronic rejection events in recipients of cadaveric renal transplants. Transplantation. 1994;57:211–17.PubMedCrossRefGoogle Scholar
  87. 87.
    Miller L. Allograft vascular disease: a disease not limited to hearts. J Heart Lung Transplant. 1992;11:S32–7.PubMedGoogle Scholar
  88. 88.
    Ip J, Fuster V, Badimon L et al. Syndromes of accelerated atherosclerosis: role of vascular injury and smooth muscle cell proliferation. J Am Coll Cardiol. 1990;15:1667–87.PubMedGoogle Scholar
  89. 89.
    Dzau V. Gibbons G, Cooke J et al. Vascular biology and medicine in the 1990s: scope, concepts, potentials and perspectives. Circulation. 1993;87:705–19.PubMedGoogle Scholar
  90. 90.
    Gibbons G, Dzau V. The emerging concept of vascular remodeling. N Engl J Med. 1994;330:1431–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Vane J. Anggard F, Botting R. Regulatory functions of the vascular endothelium. N Engl J Med. 1990;323:27–36.PubMedGoogle Scholar
  92. 92.
    Gibbons G. The pathogenesis of graft vascular disease: implications of vascular remodeling. J Heart Lung Transplant. 1996;14:5149–57.Google Scholar
  93. 93.
    Libby P, Schwartz D. Brogi E et al. A cascade model for restenosis. A special case of atherosclerosis progression. Circulation. 1993;86:III–47–52.Google Scholar
  94. 94.
    Casscells W. Migration of smooth muscle and endothelial cells. Critical events in restenosis. Circulation. 1992;86:723–9.PubMedGoogle Scholar
  95. 95.
    Heistad D, Armstrong M. Sick vessel syndrome. Can atherosclerotic arteries recover? Circulation. 1994;89:2447–50.PubMedGoogle Scholar
  96. 96.
    Billingham M. Histopathology of graft coronary disease. J Heart Lung Transplant. 1992;11:S38–44.PubMedGoogle Scholar
  97. 97.
    Johnson D, Gao S, Schroeder J et al. The spectrum of coronary artery pathologic findings in human cardiac allografts. J Heart Lung Transplant. 1989;8:349–59.Google Scholar
  98. 98.
    Billingham M. Graft coronary disease: the lesions and the patients. Transplant Proc. 1989;21:3665–6.PubMedGoogle Scholar
  99. 99.
    Libby P. Inflammatory and immune mechanisms in atherogenesis. Atherosclerosis Rev. 1990;21:79–89.Google Scholar
  100. 100.
    Salomon R, Hughes C, Schoen F et al. Human coronary transplantation-associated arteriosclerosis. Evidence for a chronic immune reaction to activated graft endothelial cells. Am J Pathol. 1991;138:791–8.PubMedGoogle Scholar
  101. 101.
    Gordon D. Growth factors and cell proliferation in human transplant arteriosclerosis. J Heart Lung Transplant. 1992;11:S7.Google Scholar
  102. 102.
    Allen M, McDonald T, Carlos T et al. Endothelial adhesion molecules in heart transplantation. J Heart Lung Transplant. 1992;11:S8–13.PubMedGoogle Scholar
  103. 103.
    Hayry P. Mennander A, Raisanen SA et al. Pathophysiology of vascular wall changes in chronic allograft rejection. Transplant Rev. 1993;7:1–20.CrossRefGoogle Scholar
  104. 104.
    Clowes A. Regulation of intimal hyperplasia through control of matrix proteolysis. Restenosis Summit V, 1993: Cleveland Clinic. 122–3.Google Scholar
  105. 105.
    Zeiher A, Schachinger V, Hohnloser S et al. Coronary atherosclerotic wall thickening and vascular reactivity in humans. Elevated high-density lipoprotein levels ameliorate abnormal vasoconstriction in early atherosclerosis. Circulation. 1994;89:2525–32.PubMedGoogle Scholar
  106. 106.
    Libby P, Hansson G. Biology of disease. Involvement of the immune system in human atherogenesis: current knowledge and unanswered questions. Lab Invest. 1991;64:5–15.1PubMedGoogle Scholar
  107. 107.
    Foegh ML, Khirabadi BS, Chambers E et al. Peptide inhibition of accelerated transplant atherosclerosis. Transplant Proc. 1989;21:3674–6.PubMedGoogle Scholar
  108. 108.
    Foegh M, Khirabadi B, Chambers E et al. Inhibition of coronary artery transplant atherosclerosis in rabbits with angiopeptin, an octapeptide. Atherosclerosis. 1989;78:229–36.PubMedCrossRefGoogle Scholar
  109. 109.
    Clowes A. Control of intimal hyperplasia by heparin. J Heart Lung Transplant. 1992:11:S21.PubMedGoogle Scholar
  110. 110.
    Faulk W, Labarrere C, Nelson D et al. Alterations in hemostasis, fibrinolysis and natural anticoagulation in transplant vascular sclerosis. J Heart Lung Transplant. 1996;14:5158–64.Google Scholar
  111. 111.
    Small F, Ballantyne C, Cocanougher B et al. Insensitivity of noninvasive tests to detect coronary artery vasculopathy after heart transplant. Am J Cardiol. 1991;67:243–7.CrossRefGoogle Scholar
  112. 112.
    Rodney R, Johnson L. Myocardial perfusion scintigraphy to assess heart transplant vasculopathy. J Heart Lung Transplant. 1992:11:S74–78.Google Scholar
  113. 113.
    McKillop J, Goris M. Thallium 201 myocardial imaging in patients with previous cardiac transplantation. Clin Radiol. 1981;32:447–9.PubMedCrossRefGoogle Scholar
  114. 114.
    Rodney R, Johnson L, Blood D et al. Myocardial perfusion scintigraphy in heart transplant recipients with and without allograft atherosclerosis: a comparison of thallium-201 and technetium 99m sestamibi. J Heart Lung Transplant. 1994;13:173–89.PubMedGoogle Scholar
  115. 115.
    Mazeika P, Nadazdin A, Oakley C. Dobutamine stress echocardiography for detection and assessment of coronary artery disease. J Am Coll Cardiol. 1992;19:1203–11.PubMedCrossRefGoogle Scholar
  116. 116.
    Herregods M, Anastassiuo I, Van Cleemput J et al. Dobutamine stress echo cardiography after heart transplantation. J Heart Lung Transplant. 1994;13:1039–44.PubMedGoogle Scholar
  117. 117.
    Akosah K, Mohanty P, Funai J et al. Noninvasive detection of transplant coronary artery disease by dobutamine stress echocardiography. J Heart Lung Transplant. 1994;13:1024–38.PubMedGoogle Scholar
  118. 118.
    Young J, Windsor N, Kleiman N et al. The relationship of soluble interleukin-2 receptor levels to allograft arteriopathy after heart transplantation. J Heart Lung Transplant. 1992;11:S79–82.Google Scholar
  119. 119.
    Rechavia E, Araujo L, DeSilva R et al. Dipyridamole vasodilator response after human orthotopic heart transplantation: quantification by oxygen-15 labeled water and positron emission tomography. J Am Coll Cardiol. 1992:19:100–6.PubMedGoogle Scholar
  120. 120.
    Gao S, Alderman E, Schroeder J et al. Accelerated coronary vascular disease in the heart transplant patient: coronary arteriographic findings. J Am Coll Cardiol. 1988;12:334–40.PubMedGoogle Scholar
  121. 121.
    Bajaj S, Shah A, Crandall C et al. Coronary collateral circulation in the transplanted heart. Circulation. 1993;88:263–9.Google Scholar
  122. 122.
    O’Neill B, Pflugfelder P, Singh N et al. Frequency of angiographic detection and quantitative assessment of coronary arterial disease one and three years after cardiac transplantation. J Am Cardiol. 1989;63:1221–6.CrossRefGoogle Scholar
  123. 123.
    Petrossian G, Nichols A, Rose E et al. Quantitative cinevideodensitometric analysis of serial coronary angiograms following cardiac transplantation. J Invas Cardiol. 1993;5:258–66.Google Scholar
  124. 124.
    deFeyter P, Serruys P, Davies M et al. Quantitative coronary angiography to measure progression and regression of coronary atherosclerosis. Circulation. 1991;84:412–23.PubMedGoogle Scholar
  125. 125.
    Mills R, Hills J, Theron H et al. Serial quantitative coronary angiography in the assessment of coronary disease in the transplanted heart. J Heart Luny Transplant. 1992;11:S52–5.Google Scholar
  126. 126.
    Everett J, Hershberger R, Ratkovec R et al. The specificity of normal qualitative angiography in excluding cardiac allograft vasculopathy. J Heart Lung Transplant. 1994;13:142–9.PubMedGoogle Scholar
  127. 127.
    Uretsky B. Kormos R, Zerbe T et al. Cardiac events after heart transplantation: incidence and predictive value of coronary arteriography. J Heart Lung Transplant. 1992;11:LS45–51.Google Scholar
  128. 128.
    Alderman F. Angiographic implications of cardiac transplantation. Am J Cardiol. 1989;64:16F–21E.CrossRefGoogle Scholar
  129. 129.
    Nitkin R, Hunt S, Schroeder J. Accelerated atherosclerosis in a cardiac transplant patient. J Am Coll Cardiol. 1985;6:243–5.PubMedGoogle Scholar
  130. 130.
    Dressler F, Miller L. Necropsy versus angiography: how accurate is angiography? J Heart Lung Transplant. 1992;3:S56–9.Google Scholar
  131. 131.
    Glagov S, Weisenberg E, Zarins C et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316:1371–5.PubMedGoogle Scholar
  132. 132.
    Glagov S. Intimal hyperplasia, vascular modeling, and the restenosis problem. Circulation. 1994;89:2888–91.PubMedGoogle Scholar
  133. 133.
    Steinke W, Hennerici M. Compensatory carotid artery dilatation in early atherosclerosis. Circulation. 1994;89:2578–81.PubMedGoogle Scholar
  134. 134.
    Losordo D, Rosenfield K, Kaufman J et al. Focal compensatory enlargement of human arteries in response to progressive atherosclerosis. In vivo documentation using intravascular ultrasound. Circulation. 1994;89:2570–7.PubMedGoogle Scholar
  135. 135.
    Post M, Borst C, Kuntz R. The relative importance of arterial remodeling compared with intimal hyperplasia in lumen renarrowing after balloon angioplasty. A study in the normal rabbit and the hypercholesterolemic Yucatan micropig. Circulation. 1994;89:2816–21.PubMedGoogle Scholar
  136. 136.
    Kakuta T. Currier J, Haudenschild C et al. Differences in compensatory vessel enlargement, not intimal formation, account for restenosis after angioplasty in the hypereholesterolemic rabbit model. Circulation. 1994,89:2809–15.PubMedGoogle Scholar
  137. 137.
    Gao S, Alderman E, Schroeder J et al. Progressive coronary luminal narrowing after cardiac transplantation. Circulation. 1990;82:IV–269–75.Google Scholar
  138. 138.
    Young J, Smart F, Lowry R et al. Coronary angiography after heart transplantation: should perioperative study be the ‘gold standard’? J Heart Lung Transplant. 1992;11:S65–8.PubMedGoogle Scholar
  139. 139.
    Boffa G, Faggian G, Buja G et al. Coronary artery spasm in heart transplant recipients. J Heart Transplant. 1989;8:154–8.PubMedGoogle Scholar
  140. 140.
    Palmer D, Tsai C, Roodman S et al. Heart graft arteriosclerosis. An ominous finding on endomyocardial biopsy. Transplantation. 1985;39:385–8.PubMedCrossRefGoogle Scholar
  141. 141.
    Mason J, Strefling A. Small vessel disease of the heart resulting in myocardial necrosis and death despite angiographically normal coronary arteries. Am J Cardiol. 1979;44:171–6.PubMedCrossRefGoogle Scholar
  142. 142.
    Neish A, Loh E, Schoen F. Myocardial changes in cardiac transplant-associated coronary arteriosclerosis: potential for timely diagnosis. J Am Coll Cardiol. 1992;19:586–92.PubMedGoogle Scholar
  143. 143.
    Sharpies L, Mullins P, Cary N et al. A method of analyzing the onset and progression of coronary occlusive disease after transplantation and its effect on patient survival. J Heart Lung Transplant. 1993;12:381–7.Google Scholar
  144. 144.
    Balk A, Simoons M, Linden M et al. Coronary artery disease after heart transplantation: timing of coronary arteriography. J Heart Lung Transplant. 1993;12:89–99.PubMedGoogle Scholar
  145. 145.
    Miller L, Wolford T, Donohue T et al. Cardiac allograft vasculopathy: new insights from intravascular ultrasound and coronary flow measurements. Transplant Rev. 1995;9:77–96.CrossRefGoogle Scholar
  146. 146.
    Miller L. The role of intracoronary ultrasound for the diagnosis of cardiac allograft vasculopathy. Transplant Proc. 1995;27(31):1989–92.PubMedGoogle Scholar
  147. 147.
    Pinto F, St. Goard F, Gao SZ et al. Immediate and one-year safety of intracoronary ultrasonic imaging. Evaluation with serial quantitative angiography. Circulation. 1993;88:1709–14.PubMedGoogle Scholar
  148. 148.
    The Safety of ICUS Study Group. Safety of intracoronary ultrasound: a multicenter, multicathetcr registry in 1837 patients. Circulation. 1993;88:I–549.Google Scholar
  149. 149.
    Pinto F, Chenzbraun A, Botas J et al. Feasibility of serial intracoronary ultrasound imaging for assessment of progression of intimal proliferation in cardiac transplant recipients. Circulation. 1994;90:2348–55.PubMedGoogle Scholar
  150. 150.
    Pflugfelder P, Boughner D, Rudas L et al. Enhanced detection of cardiac allograft arterial disease with intracoronary ultrasonographic imaging. Am Heart J. 1993; 125:1583–91.PubMedCrossRefGoogle Scholar
  151. 151.
    St Goar F, Pinto F, Alderman E et al. Detection of coronary atherosclerosis in young adult hearts using intravascular ultrasound. Circulation. 1992;86:756–63.PubMedGoogle Scholar
  152. 152.
    St Goar F, Pinto F, Alderman E et al. Intracoronary ultrasound in cardiac transplant recipients. In-vivo evidence of ‘angiographically silent’ intimal thickening. Circulation. 1992;85:979–87.PubMedGoogle Scholar
  153. 153.
    Fitzgerald P, St Goar F, Connolly A et al. Intravascular ultrasound imaging of coronary arteries. Is three layers the norm? Circulation. 1992;86:154–8.PubMedGoogle Scholar
  154. 154.
    Roelandt J, diMario C, Pandian N et al. Three-dimensional reconstruction of intracoronary ultrasound images. Rationale, approaches, problems, and directions. Circulation. 1994;90:1044–55.PubMedGoogle Scholar
  155. 155.
    Tuzcu E, DeFranco A, Hobbs R et al. Prevalence and distribution of transplant coronary artery disease: insights from intravascular ultrasound imaging. J Heart Lung Transplant. 1995;14:5202–6.Google Scholar
  156. 156.
    Nissen SE, Tuzcu M, DeFranco AC et al. Predominances of coronary disease in proximal segments with sparing of distal sites: evidence from intravascular ultrasound. J Heart Lung Transplant. 1994;13:S59.Google Scholar
  157. 157.
    Nerem R, Harrison D. Taylor W et al. Hemodynamics and vascular endothelial biology. J Cardiovasc Pharmacol. 1993;21:S6–10.PubMedCrossRefGoogle Scholar
  158. 158.
    Botas J, Pinto FJ, Chenzbraun A et al. Progression of intimal thickening after cardiac transplantation: is it influenced by preexistent donor coronary disease? J Heart Lung Transplant. 1994;13:81.Google Scholar
  159. 159.
    Yeung AC, Davis S, Hauptman P et al. Incidence and progression of transplant coronary artery disease over one year: results of a multicenter trial using intravascular ultrasound. J Heart Lung Transplant. 1995;14:5215–20.Google Scholar
  160. 160.
    Russell M, Fujita M, Masek M et al. Cardiac graft vascular disease. Nonselective involvement of large and small vessels. Transplantation. 1993;56:762–4.Google Scholar
  161. 161.
    Lin H, Wilson J, Kendall T et al. Comparable proximal and distal severity of intimal thickening and size of epicardial coronary arteries in transplant arteriopathy of human cardiac allografts. J Heart Lung Transplant. 1994;13:824–33.PubMedGoogle Scholar
  162. 162.
    Mehra M, Ventura H, Stapleton D et al. The prognostic significance of intimal proliferation in cardiac allograft vasculopathy: a paradigm shift. J. Heart Lung Transplant. 1995;14:5207–10.Google Scholar
  163. 163.
    Wiedermann JG, Wasserman HS, Weinberger JZ et al. Severe intimal thickening by intracoronary ultrasound predicts early death in cardiac transplant recipients. Circulation. 1994;90:1–93.Google Scholar
  164. 164.
    Johnson J, Kobashigawa J. Quantitative analysis of transplant coronary artery disease using intracoronary ultrasound. J Heart Lung Transplant. 1995;14:5198–201.Google Scholar
  165. 165.
    Waller B, Pinkerton C, Slack J. Intravascular ultrasound: a histological study of vessels during life. The new ‘gold standard’ for vascular imaging. Circulation. 1992;85:2305–10.PubMedGoogle Scholar
  166. 166.
    Doucette T, Carl P, Payne H et al. Validation of a doppler guidewirc for intravascular measurement of coronary flow velocity. Circulation. 1992;85:1879–1911.Google Scholar
  167. 167.
    McGinn A, White C, Wilson R. Interstudy variability of coronary flow reserve. Influence of heart rate, arterial pressure, and ventricular preload. Circulation. 1990;81:1319–30.PubMedGoogle Scholar
  168. 168.
    Wolford T, Donohue T, Drury J et al. Extent of coronary myointimal proliferation and its relationship to resistance vessel function in the cardiac allograft. J Am Coll Cardiol. l995(Special issue): 158(abstract).Google Scholar
  169. 169.
    Wolford T, Donohue T, Bach R et al. Coronary flow reserve in angiographically normal coronary arteries varies with time post-transplantation. Eur Heart J. 1994;15:P3237.Google Scholar
  170. 170.
    Bitar JN, Young JB, Vardan S et al. Progressive deterioration of coronary reserve after heart transplant: a time-dependent observation. J Am Coll Cardiol. 1994 (Special issue):230A (abstract).Google Scholar
  171. 171.
    Ventura H, White C, Jain S et al. Assessment of intracoronary morphology in cardiac transplant recipients by angioscopy and intravascular ultrasound. Am J Cardiol. 1993;72:805–9.PubMedCrossRefGoogle Scholar
  172. 172.
    Mills R, Billett J, Nichols W. Endothelial dysfunction early after heart transplantation. Assessment with intravascular ultrasound and doppler. Circulation. 1992;86:1171–4.PubMedGoogle Scholar
  173. 173.
    Fish R, Nabel E, Selwyn A et al. Responses of coronary arteries of cardiac transplant patients to acetylcholine. J Clin Invest. 1988;81:21–31.PubMedCrossRefGoogle Scholar
  174. 174.
    Treasure C, Vita J, Ganz P et al. Loss of the coronary microvascular response to acetylcholine in cardiac transplant patients. Circulation. 1992;86:1156–64.PubMedGoogle Scholar
  175. 175.
    Yeung A, Anderson T, Meredith I et al. Endothelial dysfunction in the development and detection of transplant coronary artery disease. J Heart Lung Transplant. 1992;11:869–73.Google Scholar
  176. 176.
    Brown B, Maher V. Key references. Reversal of coronary heart disease by lipid lowering therapy. Observations and pathological mechanisms. Circulation. 1994;89:2928–33.PubMedGoogle Scholar
  177. 177.
    Superko H, Krauss R. Coronary artery disease regression. Convincing evidence for the benefit of aggressive lipoprotein management. Circulation. 1994;90:1056–69.PubMedGoogle Scholar
  178. 178.
    Anguita M, Alonso-Pulpon L. Arizon J et al. Comparison of the effectiveness of Iovastatin therapy for hypercholesterolemia after heart transplantation between patients with and without pretransplant atherosclerotic coronary artery disease. Am J Cardiol. 1994;74:776–9.PubMedCrossRefGoogle Scholar
  179. 179.
    Ballantyne C, Radovancevic B, Farmer J et al. Hyperlipidemia after heart transplantation: report of a 6 year experience with treatment recommendations. J Am Coll Cardiol. 1992;19:1315–21.PubMedGoogle Scholar
  180. 180.
    Kobashigawa JA, UCLA Transplant Program. 1993 Unpublished data. Presented to the American Society of Transplant Physicians meeting, 1994, Chicago.Google Scholar
  181. 181.
    Kobashigawa JA, Katznelson S, Laks H et al. Effect of pravastatin on outcome after cardiac transplantation. N Engl J Med. 1995;333:621–7.PubMedCrossRefGoogle Scholar
  182. 182.
    Eich D. Thompson J, Ko D et al. Hypercholesterolemia in long-term survivors of heart transplantation: an early marker of accelerated coronary artery disease. J Heart Lung Transplant. 1991;10:45–9.PubMedGoogle Scholar
  183. 183.
    Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing physicians’ health study. N Engl J Med. 1989;321:129–35.Google Scholar
  184. 184.
    Fuster V, Cohen M, Halperin J. Aspirin in the prevention of coronary disease. N Engl J Med. 1989;321:183–5.PubMedGoogle Scholar
  185. 185.
    Hoyt G, Gollin G, Billingham M et al. Effects of anti-platelet regimens in combination with cyclosporin on heart allograft vessel disease. J Heart Lung Transplant. 1984;4:54–6.Google Scholar
  186. 186.
    Muskett A, Burton N, Eichwald E et al. The effect of antiplatelet drugs on graft atherosclerosis in rat heterotopic cardiac allografts. Transplant Proc. 1987;19:74–6.PubMedGoogle Scholar
  187. 187.
    DeLorgeril M, Boissonnat P, Guidollet J et al. Clinical and laboratory risk factors for coronary heart disease in cardiac transplanted patients. 1989; XXI Course on Transplantation and Clinical Immunology. Amsterdam: Elsevier.Google Scholar
  188. 188.
    Grace A, Barradas M, Mikhailidis D et al. Cyclosporin A enhances platelet aggregation. Kidney Int. 1987;32:889–95.PubMedCrossRefGoogle Scholar
  189. 189.
    Schroeder J, Gao S, Alderman E et al. A preliminary study of diltiazem in the prevention of coronary artery disease in heart transplant recipients. N Engl J Med. 1993;328:164–70.PubMedCrossRefGoogle Scholar
  190. 190.
    Henry P. Calcium channel blockers and progression of coronary artery disease. Circulation. 1990;82:2251–3.PubMedGoogle Scholar
  191. 191.
    Paoletti R, Bernini F. A new generation of calcium antagonists and their role in atherosclerosis. Am J Cardiol. 1990;66:H28–31.CrossRefGoogle Scholar
  192. 192.
    Waters D, Lesperance J, Francetich M et al. A controlled clinical trial to assess the effect of a calcium channel blocker on the progression of coronary atherosclerosis. Circulation. 1990;82:1940–53.PubMedGoogle Scholar
  193. 193.
    Alivizatos P, Maxa J, Lucio S et al. The immunosuppressive qualities of calcium channel blockers. (Letter to editor) Transplantation. 1993;56:1604.PubMedCrossRefGoogle Scholar
  194. 194.
    Sarris G, Mitchell R, Billingham M et al. Inhibition of accelerated cardiac allograft arteriosclerosis by fish oil. J Thurac Cardiovasc Surg. 1989;97:841–55.Google Scholar
  195. 195.
    Israel D, Gorlin R. Fish oils in the prevention of atherosclerosis. J Am Coll Cardiol. 1992;19:174–85.PubMedGoogle Scholar
  196. 196.
    Bairati I, Roy L, Meyer F. Double-blind, randomized, controlled trial of fish oil supplements in prevention of recurrence of stenosis after coronary angioplasty. Circulation. 1992;85:950–6.PubMedGoogle Scholar
  197. 197.
    Young J. Fish oil and antioxidants after heart transplant: future strategies or eye of newt and wing of bat revisited? J Heart Lung Transplant. 1995;14:5250–4.Google Scholar
  198. 198.
    Gibbons G. Preventive treatment of graft coronary vascular discase: the potential role of vasodilator therapy. J Heart Lung Transplant. 1992;11:S22–7.Google Scholar
  199. 199.
    Powell JS, Clozel JP, Muller RK et al. Inhibitors of angiotensin-converting enzyme prevent myointimal proliferation after vascular injury. Science. 1989;245:186–8.PubMedCrossRefGoogle Scholar
  200. 200.
    Foegh ML, Zhao Y, Lou H et al. Estrogen and prevention of transplant atherosclerosis. J Heart Lung Transplant. (In press).Google Scholar
  201. 201.
    Foegh M. Angiopeptin: a treatment for accelerated myointimal hyperplasia? J Heart Lung Transplant. 1992;11:S28–31.PubMedGoogle Scholar
  202. 202.
    Wahlers T, Mugge A, Oppelt P et al. Preventive treatment of coronary vasculopathy in heart transplantation by inhibition of smooth muscle cell proliferation with angiopeptin. J Heart Lung Transplant. 1994;14:143–50.Google Scholar
  203. 203.
    Meiser BM, Mair H, Scheidt W et al. Significant reduction of graft vessel disease (GVD) after heart transplantation (HTx) by short-term angiopeptin treatment. Presented to the American Society of Transplant Physicians meeting, 1995, Chicago.Google Scholar
  204. 204.
    Gregory C, Huang X, Pratt R et al. Treatment with rapamycin and mycophenolic acid reduces arterial intimal thickening produced by mechanical injury and allows endothelial replacement. Transplantation. 1995;59:655–61.PubMedCrossRefGoogle Scholar
  205. 205.
    Morris RE. Rapamycins: antifungal, antitumor, antiproliterative, and immunosuppressive macrolides. Transplant Rev. 1992;6:39.Google Scholar
  206. 206.
    Gregory C, Huie P, Billingham M et al. Rapamycin inhibits arterial intimal thickening caused by both alloimmune and mechanical injury. Transplantation. 1993;55:1409–18.PubMedCrossRefGoogle Scholar
  207. 207.
    Gao S, Schroeder J. Hunt S et al. Retransplantation for severe accelerated coronary artery disease in heart transplant recipients. Am J Cardiol. 1988;62:876–81.PubMedCrossRefGoogle Scholar
  208. 208.
    Ensley R, Hunt S, Taylor D et al. Predictors of survival after repeat heart transplantation. J Heart Lung Transplant. 1992;11:S142–58.Google Scholar
  209. 209.
    Christensen B, Meyer S, Iacarella C et al. Coronary angioplasty in heart transplant recipients: a quantitative angiographic long-term follow-up study. J Heart Lung Transplant. 1994;13:212–20.PubMedGoogle Scholar
  210. 210.
    Halle A. Wilson R, Massin R et al. Coronary angioplasty in cardiac transplant patients. Results of a multicenter study. Circulation. 1992;86:458–62.PubMedGoogle Scholar
  211. 211.
    Halle A, DiSciascio G, Massin F et al. Coronary angioplasty, atherectomy, and bypass surgery in cardiac transplant patients. J Am Coll Cardiol. 1995;26:120–8.PubMedCrossRefGoogle Scholar
  212. 212.
    Jain S, Ventura H, Ramee S et al. Directional coronary atherectomy in heart transplant recipients. J Heart Lung Transplant. 1993;12:819–23.PubMedGoogle Scholar
  213. 213.
    Roberts M, Parameshwar J, Wallwork J et al. Coronary revascularization after cardiac transplantation. J Heart Lung Transplant. 1994;13:S48.Google Scholar
  214. 214.
    Heroux A, Winkel E, Johnson S et al. Cardiac allograft vasculopathy: angiographic features and implications for revascularization. Circulation. 1994;90:I–362 (abstract).Google Scholar
  215. 215.
    King S, Lembo N, Weintraub W et al. A randomized trial comparing coronary angioplasty with coronary bypass surgery. N Engl J Med. 1994;331:1044–50.PubMedCrossRefGoogle Scholar
  216. 216.
    Kron I, Flanagan T. Blackbourne L et al. Coronary revascularization rather than cardiac transplantation for chronic ischemic cardiomyopathy. Ann Surg. 1989;210:348–54.PubMedCrossRefGoogle Scholar
  217. 217.
    Cooley DA, Frazier OH, Kadipasaoglu KA et al. Transmyocardial laser revascularization: anatomic evidence of long-term channel patency. Texas Heart Inst J. 1994;21:220–4.Google Scholar
  218. 218.
    Frazier OH, Cooley DA, Kadipasaoglu KA et al. Transmyocardial laser revascularization: initial clinical results. Circulation. 1994;90:I–640 (abstract).Google Scholar
  219. 219.
    March RJ. Cardiac allograft vasculopathy: the potential role for transmyocardial laser revascularization. J Heart Lung Transplant. 1995;14:5242–9.Google Scholar
  220. 220.
    Ortu P, LaMuraglia G, Roberts G et al. Photodynamic therapy of arteries. A novel approach for treatment of experimental intimal hyperplasia. Circulation. 1992;85:1189–96.PubMedGoogle Scholar
  221. 221.
    Dartsch P, Ischinger T, Betz E. Response of cultured smooth muscle cells from human nonatherosclerotic arteries and primary stenosing lesions after photo radiation: implication for photodynamic therapy of vascular stenosis. J Am Coll Cardiol. 1990:15:1545–50.PubMedGoogle Scholar
  222. 222.
    Fyfe A, Ardehali A, Laks H et al. Biologic modification of the immune response in mouse cardiac isografts using gene transfer. J Heart Lung Transplant. 1995;14:5165–9.Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • L. W. Miller
  • T. Donahue
  • T. Wolford
  • J. Drury

There are no affiliations available

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