Vascular Tissue Plasminogen Activator and the Development of Coronary Artery Disease in Heart-Transplant Recipients

The development of coronary artery disease after cardiac transplantation is a leading cause of graft failure in recipients who survive the first year after operation. 1 , 2 This transplantation-associated arteriopathy is characterized by rapid development, 3 , 4 the concentric narrowing of smaller coronary arteries, 5 , 6 and the lack of correlation with known atherogenic risk factors. 1 – 6 In normal hearts and stable cardiac allografts the distribution of tissue plasminogen activator (t-PA) has been found to be limited to the vascular smooth-muscle cells of arteries and arterioles. 7 – 10 Biopsies of failing cardiac allografts have shown depletion of t-PA from vascular smooth-muscle cells, 9 – 11 and . . .