**8. Prevention for coronary allograft vasculopahy**

One of the major limitations of heart transplantation is coronary allograft vasculopathy (CAV), which is called chronic rejection and occurs in 50% after 5 years of transplantation (**Figure 1**) [8–10]. The recommended nomenclature for cardiac allograft vasculopathy is based on the ISHLT proposed, adapted in **Table 8**. Coronary angiography is the gold standard for the diagnosis; however, in adult population, intravascular ultrasound can be used to detect coronary lesions as well as optical coherence tomography (OCT). **Table 9** shows the methods for CAV diagnosis. Prevention for CAV includes some strategies described in **Table 10**.

**Figure 1.** *Coronary angiography shows CAV lesions in left coronary artery.*


#### **Table 8.**

*ISHLT CAV nomenclature (adapted).*


DSE (dobutamine stress echocardiogram)

#### **Table 9.**

*Methods for CAV diagnosis.*

Control of cardiac risk factors (hypertension, diabetes, hyperlipidemia, smoking, obesity

Prevention CMV

Statin therapy

Substitution of mychophenolate or azathioprine to proliferation signal inhibitors

**Table 10.** *Prevention for CAV.*

### **9. Conclusion**

Prevention of rejection is one of the most important issues in heart transplantation. Although there are many drugs that can be used to prevent rejection, rejection is still one of the major complications after transplantation and causes of death.

*Strategies for Prevention and Management of Heart Transplant Rejection DOI: http://dx.doi.org/10.5772/intechopen.114145*
