Immunological and non-immunological markers of cardiac allograft vasculopathy amongst heart transplant recipients

Abstract

Cardiac allograft vasculopathy (CAV) is a unique form of accelerated atherosclerosis in heart transplant recipients that limits long-term survival. The pathophysiology of CAV is not fully clear, but is likely to be mulitfactorial with a range of immunological and non-immunological contributors. The aims of this thesis were to investigate the prognostic significance of both immunological and non-immunological markers of CAV. Paper I examines the role of the neurohormonal biomarker, NT-proBNP, and the inflammatory biomarker, CRP, in identifying patients at higher risk of CAV and cardiac mortality. Paper II explores the prognostic significance of impaired renal function following heart transplantation and the associated risk of CAV and mortality. In paper III, the role of chronic infection with the parasite T.gondii is investigated in relation to CAV. Finally, in paper IV, intravascular ultrasound is employed with parallel measurement of a broad range of inflammatory biomarkers to help allow identification of novel markers of CAV. The findings of this thesis demonstrate that both immunological and non-immunological markers can be utilized to accurately identify patients at higher risk of developing CAV and routine measurement in clinical practice could, potentially, help improve long-term survival following heart transplantation.