Medication management of cardiac allograft vasculopathy after heart transplantation

Pharmacotherapy. 2015 May;35(5):489-501. doi: 10.1002/phar.1580.


Cardiac allograft vasculopathy (CAV) is a common complication following heart transplantation (HT), resulting in diminished graft survival. The preferred strategy for preventing CAV is optimal medical management; however, for patients who develop CAV, delaying disease progression through effective medication management is equally important. A review of the literature regarding medication management of CAV was conducted via a search of the MEDLINE database. Studies were included if they were published in English, conducted in humans ≥ 18 years of age or older, and used noninvestigational medications. Immunosuppressive medications such as the antiproliferative mycophenolate, the calcineurin inhibitor tacrolimus, and the proliferation signal inhibitors sirolimus and everolimus have been shown to prevent the development of CAV. Certain cardiovascular medications, such as HMG-CoA reductase inhibitors (statins), gemfibrozil, calcium channel blockers, and angiotensin-converting enzyme inhibitors, have also demonstrated efficacy in preventing this disease process. Prevention of CAV has also been observed with prophylaxis against cytomegalovirus infection and antioxidant medications. Despite being commonly used in HT patients, neither antiplatelet agents nor glycemic control have proved effective at preventing CAV. Only sirolimus has been shown to arrest the progress of existing CAV.

Keywords: HMG CoA reductase inhibitors; angiotensin-converting enzyme inhibitors; antioxidants; antiplatelet agents; calcium channel blockers; coronary artery disease; cytomegalovirus; heart transplantation; immunosuppressive agents.

Publication types

  • Review

MeSH terms

  • Allografts
  • Antioxidants / therapeutic use
  • Calcineurin Inhibitors / therapeutic use
  • Cardiovascular Agents / therapeutic use
  • Cytomegalovirus Infections / prevention & control
  • Everolimus / therapeutic use
  • Graft Occlusion, Vascular / immunology
  • Graft Occlusion, Vascular / pathology
  • Graft Occlusion, Vascular / prevention & control*
  • Graft Rejection / immunology
  • Graft Rejection / pathology
  • Graft Rejection / prevention & control*
  • Graft Survival
  • Heart Transplantation*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Mycophenolic Acid / therapeutic use
  • Postoperative Complications / immunology
  • Postoperative Complications / pathology
  • Postoperative Complications / prevention & control*
  • Sirolimus / therapeutic use
  • Tacrolimus / therapeutic use


  • Antioxidants
  • Calcineurin Inhibitors
  • Cardiovascular Agents
  • Immunosuppressive Agents
  • Everolimus
  • Mycophenolic Acid
  • Sirolimus
  • Tacrolimus