As symptoms are so variable and often absent, diagnosis has been a challenge. Hence, regular follow-up and monitoring of the<unk>  for early signs of disease is advocated. Coronary angiography Surveillance is performed by regularly repeating coronary angiography in the<unk>  catheterization laboratory, the diagnostic test of choice. This is typically performed annually for the first five years after transplantation. Angiography in<unk>  characteristically demonstrates diffuse stenoses in large coronary arteries and a reduced number of smaller coronary arteries, also known as "peripheral pruning". However, because<unk>  frequently affects the entire length of the coronary artery,<unk>  may not be apparent by angiography alone. Intravascular ultrasound (IVUS) Intravascular ultrasound (IVUS) is more sensitive at reliably detecting subtle changes in the thickness of the intimal layer of the artery walls and provide measurements of artery lumen. Following transplantation, serial measurements are compared to the baseline. A greater than 0.5 mm increase in intimal thickness one year after transplantation is predictive of<unk>  changes on angiography within five years. The paradoxical reduction in the number of blood vessels, can also be detected by intravascular ultrasound. IVUS, however, tends to be used for research due to its drawbacks of being invasive, requiring the use of contrast material and cost. Dobutamine stress-echocardiography (DSE) Alternatively, dobutamine stress echocardiography (DSE) is commonly performed and has an 85% sensitivity for the presence of<unk> . A negative DSE correlates with a good prognosis. Other noninvasive diagnostics include positron emission tomography and computed tomographic angiography (CT angiography). In addition, ECGs may show atypical features of ischaemia. Biomarkers Biomarkers for increased risk of<unk>  include C-reactive protein, serum brain natriuretic peptide and troponin I have been suggested. Classification The degree of<unk>  after heart transplantation has been obtained from a variety of sources including The<unk>  Transplant Research Database, the ISHLT registry and The United Network for Organ Sharing registry. The International Society for Heart and Lung Transplantation (ISHLT) have formulated and standardized a terminology, based on diagnostic findings, to define the presence and severity of<unk> , which in turn reflects prognosis. The severity of<unk>  is defined by the degree of narrowing of the coronary arteries and the presence of restrictive heart disease. Code Severity Diagnostic findings ISHLT<unk> 0 Not significant No detectable lesions on angiography ISHLT<unk> 1 Mild Angiographic left main (LM) 􏰁50%, or primary vessel with maximum lesion of 􏰁70%, or any branch stenosis 􏰁70% (including diffuse narrowing) without<unk>  dysfunction ISHLT<unk> 2 Moderate Angiographic LM 􏰁50%; a single primary vessel 􏰄70%, or isolated branch stenosis 􏰄70% in branches of 2 systems, without<unk>  dysfunction ISHLT<unk> 3 Severe Angiographic LM 􏰄50%, or two or more primary vessels 􏰄70% stenosis, or isolated branch stenosis 􏰄70% in all 3 systems; or ISHLT<unk> 1 or<unk> 2 with<unk>  dysfunction (defined as LVEF 􏰅45% usually in the presence of regional wall motion abnormalities) or evidence of significant restrictive physiology
Cardiac allograft vasculopathy
Graft-versus-host disease
Chronic allograft nephropathy
Transplant rejection
Cardiac amyloidosis
Extrapulmonary tuberculosis
Vasculogenic mimicry
Transplant glomerulopathy