A 30-year-old man had a cardiac transplant 5 years previously because of dilated cardiomyopathy. He initially did very well post-transplant. However, he has noticed that he is progressively short of breath on exertion. His TTE shows mid and apical anterior hypokinesia.
What is the most likely diagnosis?
A. Acute T-cell rejectionThe patient most likely has coronary vasculopathy. The incidence of this is 30–40% at 5 years. It progresses slowly, but as the heart is denervated a high clinical suspicion is required.