Cytomegalovirus Replication and “Herpesvirus Burden” as Risk Factor of Cardiovascular Events in the First Year After Renal Transplantation

• Published in: Transplantation proceedings Vol. 37; no. 9; pp. 3760 - 3763
• Main Authors: Gómez, E., Laurés, A., Baltar, J.M., Melón, S., Dı́ez, B., de Oña, M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2005; Elsevier Science
• Subjects: Adolescent; Adult; Aged; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cytomegalovirus - physiology; Cytomegalovirus Infections - epidemiology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Herpes Simplex - epidemiology; Herpesviridae - physiology; Homocysteine - blood; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Male; Medical sciences; Middle Aged; Postoperative Complications - virology; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Tissue, organ and graft immunology; Virus Replication; Opportunistic infection; Herpesviridae; Alphaherpesvirinae; Cardiovascular disease; Homotransplantation; Betaherpesvirinae; Epidemiology; Kidney; Human cytomegalovirus; Infection; Vascular disease; Virus; Medicine; Treatment; Urinary system; Surgery; Viral disease; Atherosclerosis; Risk factor; Cardiovascular risk; Graft; Replication; Herpesvirus hominis; Kidney transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.08.058

Cytomegalovirus (CMV) infection alone or in combination with other pathogens (“pathogen burden”) has been postulated as a factor producing arteriosclerosis in some solid organ transplant recipients. The aim of this study was to assess whether the patients with CMV replication and/or “herpesvirus burden” experienced a greater incidence of cardiovascular events during the first year after kidney transplantation. One hundred twenty-one consecutive transplant recipients were prospectively studied for CMV replication using antigenemia and polymerase chain reaction (PCR) weekly during the 4 first months, and monthly thereafter for 1 year. Simultaneously, nested-PCR for human herpes virus (HHV)-6 and HHV-7 were performed to yield a herpesvirus burden (as determined by seropositivity), including CMV, herpes simplex virus (HSV), varicella-zoster virus (VZV), and Epstein-Barr virus (EBV). The following additional parameters were analyzed: gender, age, smoking, duration of dialysis, preexistent diabetes, and preexistent cardiovascular events. After 1 year posttransplantation cardiovascular events, body mass index, arterial hypertension, number of antihypertensive drugs, use of ACE and/or ARBs inhibitors, diabetes, anemia, homocysteine, creatinine, cholesterol, HDLc, LDLc, PTH-i, proteinuria, and immunosuppression with cyclosporine or tacrolimus. CMV replication was present in 79 (65.3%) patients. Among 121 renal transplant recipients, 13 presented cardiovascular events, all associated with CMV replication ( P = .004). Neither HHV-6 or HHV-7 replication influenced this complication. All patients with these events were seropositive for CMV, HSV, VZV, and EBV, as opposed to 64.8% without them ( P = .009). Other factors that showed differences between patients with versus without events were as follows: preexistent events (76.9% vs 14.8%; P = .000), age (60 ± 10 vs 49 ± 14; P = .002), serum triglyceride value (191 ± 82 vs 135 ± 72; P = .02), and anemia (23.1% vs 5.6%; P = .05). Multiple logistic regression analysis for statistically significant variables only showed that preexistent events influenced the development of posttransplantation events (odds ratio, 27; 95% confidence interval, 4.7–154; P = .0005). In conclusion, cardiovascular events within 1 year after transplantation were more frequent among patients with CMV replication and seropositivity for other herpesviruses. An important risk factor was the presence of preexistent events.