Virchows Archiv

, Volume 464, Issue 6, pp 627–635 | Cite as

Coronary cardiac allograft vasculopathy versus native atherosclerosis: difficulties in classification

  • Annalisa Angelini
  • Chiara Castellani
  • Marny Fedrigo
  • Onno J. de Boer
  • Lorine B. Meijer-Jorna
  • Xiaofei Li
  • Marialuisa Valente
  • Gaetano Thiene
  • Allard C. van der Wal
Review and Perspectives


Cardiac allograft vasculopathy is regarded as a progressive and diffuse intimal hyperplastic lesion of arteries and veins that leads to insidious vessel narrowing and to allograft ischemic disease, such as acute myocardial infarction or sudden cardiac death. The coronary lesions in transplanted hearts are considered as a particular type of arteriosclerosis with many similarities but also significant differences compared to native coronary atherosclerosis. It is particularly difficult for pathologists to systematically classify the lesions and to elucidate their origins, since over time, the allograft immune responses cause vascular pathology characterized by not only the onset of de novo fibrocellular lesions but also remodeling of already-existing native atherosclerotic lesions in the donor heart. Intraplaque hemorrhages, which result from newly formed leaky microvessels, may cause rapid increase of stenosis and generate a substrate for plaque destabilization. Comparing cardiac allograft vasculopathy from explanted hearts at autopsy with native coronary atherosclerosis from hearts removed at transplantation has revealed that ongoing intraplaque hemorrhages are also an important feature of cardiac allograft vasculopathy and may be important factors in the rapid progression of cardiac allograft vasculopathy.


Cardiac allograft vasculopathy Intraplaque hemorrhage Adventitia remodeling Atherosclerosis Inflammation 



The authors thank the Association for European Cardiovascular Pathology (AECVP). The authors thank Marco Pizzigolotto, Elisabetta Baliello, and Daniele Iannazzone for skillful technical assistance. This work was also supported by a research grant from University of Padua: PDR099073, CPDA108809, 60A07-5074, and 60A07-8587

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Annalisa Angelini
    • 1
  • Chiara Castellani
    • 1
  • Marny Fedrigo
    • 1
  • Onno J. de Boer
    • 2
  • Lorine B. Meijer-Jorna
    • 2
  • Xiaofei Li
    • 2
  • Marialuisa Valente
    • 1
  • Gaetano Thiene
    • 1
  • Allard C. van der Wal
    • 2
  1. 1.Department of Cardiac, Thoracic and Vascular SciencesUniversity of PaduaPaduaItaly
  2. 2.Department of PathologyAcademic Medical Center/University of AmsterdamAmsterdamThe Netherlands

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