A Rationale for Hormone Replacement Therapy in Organ Transplant Patients

  • Marie L. Foegh
Part of the Medical Science Symposia Series book series (MSSS, volume 13)


Estrogens are steroid hormones that have important roles in the cardiovascular system and in maintenance of bone tissue. These effects are mediated by a ligand-activated transcription factor, the estrogen receptor (ER) [1]. Clinically the question arises as to whether estrogen replacement therapy (ERT) is indicated in postmenopausal recipients of organ transplants. Post-transplantation hypertension, hyperlipidemia, and insulin dependent diabetes develop in the immunosuppressed recipient. Renal transplant patients are already at high risk for cardiovascular complications of atherosclerosis and many patients have severe osteoporosis at the time they receive a renal allograft. The well-known female advantage in cardiovascular disease prior to menopause appears to be abrogated in transplant recipients. The female origin of the allograft appears to be a risk factor. The reason for the difference in risk of atherosclerosis/arteriosclerosis in the female organ in its natural host compared to in the transplant host is most likely of immune origin and is most spectacularly seen in the coronary arteries of the cardiac allograft. This graft arteriosclerosis presents as a characteristic vasculopathy consisting of a continous concentric myointimal thickening which is universal in all solid organ allografts and limits long-term graft and patient survival.


Estrogen Receptor Estrogen Replacement Therapy Cardiac Allograft Balloon Injury Aorta Allograft 
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© Kluwer Academic Publishers and Fondazione Giovanni Lorenzini 1999

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  • Marie L. Foegh

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