A Rationale for Hormone Replacement Therapy in Organ Transplant Patients
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) . 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.
KeywordsEstrogen Receptor Estrogen Replacement Therapy Cardiac Allograft Balloon Injury Aorta Allograft
Unable to display preview. Download preview PDF.
- 3.Foegh M, Rego A, Lou H, Katz N, Ramwell P. Gender effects on graft myointimal hyperplasia. Transpl Proc 1995;27:2070–73.Google Scholar
- 9.Lou H, Martin MB, Stoica A, Ramwell PW, Foegh ML. Upregulation of estrogen receptor-α expression in cardiac allograft. Circ Res In press.Google Scholar
- 11.Foegh ML, Khirabadi BS, Nakanishi T, Vargas R, Ramwell PW. Estradiol protects against experimental cardiac transplant atherosclerosis. Transpl Proc 1987;19:90–94.Google Scholar
- 14.Saito S, Foegh ML, Motomura N, Lou H, Kent K, Ramwell PW. Estradiol inhibits allograft inducible major histocompatibility MHC-class II antigen expression and transplant arteriosclerosis in the absence of immuno-suppression. Transplantation In press.Google Scholar
- 15.Foegh ML, Ramwell PW. The protective effect of estradiol in transplant arteriosclerosis. In: Rabuanyi G, Kauffman R, editors. Estrogens and the vessel wall. Amsterdam: Harwood Academic Publishers, 1998:213–24.Google Scholar