Treatment
Statins
Prevention of CAV progression is important as once developed, CAV existing treatments are often ineffective. Commencing the statins pravastatin and simvastatin early after transplantation reduces the incidence and severity of CAV. Vitamins
When combined with immunosuppressants, the progression of CAV could possibly be slowed by vitamins C and E.

Aspirin
Since the role of aspirin is already established in coronary artery disease in those who have not had a heart transplant, it is usually given after heart transplantation too. Antiproliferative agents
On detection of CAV, medications including mTOR inhibitors sirolimus and everolimus have been shown to slow disease progression. Other treatment options
Clinically significant CAV may require percutaneous coronary interventions for focal disease, but the likelihood of restenosis is high. A repeat heart transplantation may be considered. Outcome
Once there is reduced left ventricular ejection fraction and symptoms of heart failure, the outcome is typically poor. The risk of major adverse cardiovascular events is increased by 3.4 fold if CAV is present on angiography. Epidemiology
The frequency of CAV after heart transplantation has been obtained from a variety of sources including The Cardiac Transplant Research Database, the ISHLT registry and The United Network for Organ Sharing registry. In comparison to between 1994 and 2001, there has been a decline in incidence of CAV between 2001 and 2007. ISHLT figures show an incidence of CAV of around 50% at 10 years after heart transplantation.CAV is a leading cause of late mortality following heart transplantation. Most are not severe but it contributes to the death of 11-13% one year from heart transplantation.
However, in CAV, histology specimens typically show concentric thickening of the intimal layer of the main coronary arteries on the surface of the heart and in intramyocardial arteries which can become obliterated within a few years. There is smooth muscle cell migration, foamy macrophages and lymphocytic infiltrates. This can be seen to affect the whole length of the coronary arteries and often the smaller arteries. Calcification does not always occur in CAV and if it does appear, it happens late. The compensatory arterial dilation does not occur in CAV. Unlike in nontransplanted people with coronary artery disease due to atherosclerosis, in CAV occlusion with thrombus of the vessel lumen is rare.Inflammation and endothelial injury can be triggered by the donor arrest, organ procurement, and allograft ischaemia and reperfusion. Diagnosis
As symptoms are so variable and often absent, diagnosis has been a challenge. Hence, regular follow-up and monitoring of the allograft for early signs of disease is advocated. Coronary angiography
Surveillance is performed by regularly repeating coronary angiography in the cardiac catheterization laboratory, the diagnostic test of choice. This is typically performed annually for the first five years after transplantation. Angiography in CAV characteristically demonstrates diffuse stenoses in large coronary arteries and a reduced number of smaller coronary arteries, also known as "peripheral pruning". However, because CAV frequently affects the entire length of the coronary artery, CAV may not be apparent by angiography alone.