Graft atherosclerosis in the transplant heart is essentially asymptomatic due to denervation of the transplant heart and also is rapidly progressive. After one year it is the major cause of transplant rejection. Histopathologically, graft atherosclerosis differs from the conventional atherosclerosis. Intravascular ultrasound and repeated coronary angiography help in its early diagnosis. Angioplasty and bypass graft surgery are not of much help in treatment. Preventive measures through dietary means to keep triglycerides under control and prophylactic use of calcium channel blocker diltiazem are rewarding. Many patients with graft coronary atherosclerosis end up with retransplant.
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