Viral Endomyocardial Infection Is an Independent Predictor and Potentially Treatable Risk Factor for Graft Loss and Coronary Vasculopathy in Pediatric Cardiac Transplant Recipients
Objectives This study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. Background Viral myocardial infection causes heart failure, but its role after cardiac transplantation is unclear. We hypothesized that viral infection of the cardiac...
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Published in | Journal of the American College of Cardiology Vol. 56; no. 7; pp. 582 - 592 |
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Main Authors | , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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New York, NY
Elsevier Inc
10.08.2010
Elsevier Elsevier Limited |
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Abstract | Objectives This study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. Background Viral myocardial infection causes heart failure, but its role after cardiac transplantation is unclear. We hypothesized that viral infection of the cardiac allograft reduces graft survival. Methods Between June 1999 and November 2004, 94 pediatric cardiac transplant patients were screened for the presence of viral genome in serial endomyocardial biopsies (EMBs) using polymerase chain reaction (PCR) assays. Graft loss, advanced transplant coronary artery disease (TCAD), and acute rejection (AR) were compared in the PCR-positive (n = 37) and PCR-negative (n = 57) groups, using time-dependent Kaplan-Meier and Cox regression analyses. From November 2002 to November 2004, intravenous immunoglobulin therapy (IVIG) was administered to patients with PCR-positive EMBs. The outcomes of the IVIG-treated, PCR-positive patients (n = 20) were compared with IVIG-untreated, PCR-positive patients (n = 17). Results Viral genomes were detected in EMBs from 37 (39%) patients; parvovirus B19, adenovirus, and Epstein-Barr virus (EBV) were the most common. The PCR-positive group (n = 37, 25% graft loss at 2.4 years) had decreased graft survival (p < 0.001) compared with the PCR-negative group (n = 57, 25% graft loss at 8.7 years) and developed advanced TCAD prematurely (p = 0.001). The number of AR episodes was similar in both groups. On multivariate analysis, presence of viral genome was an independent risk factor for graft loss (relative risk: 4.2, p = 0.015). The time to advanced TCAD after becoming PCR-positive was longer in the IVIG-treated patients (p = 0.03) with a trend toward improved graft survival (p = 0.06). Conclusions Viral endomyocardial infection is an independent predictor of graft loss in pediatric cardiac transplant recipients. This effect appears to be mediated through premature development of advanced TCAD. IVIG therapy in this subgroup may improve survival and merits further investigation. |
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AbstractList | Objectives This study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. Background Viral myocardial infection causes heart failure, but its role after cardiac transplantation is unclear. We hypothesized that viral infection of the cardiac allograft reduces graft survival. Methods Between June 1999 and November 2004, 94 pediatric cardiac transplant patients were screened for the presence of viral genome in serial endomyocardial biopsies (EMBs) using polymerase chain reaction (PCR) assays. Graft loss, advanced transplant coronary artery disease (TCAD), and acute rejection (AR) were compared in the PCR-positive (n = 37) and PCR-negative (n = 57) groups, using time-dependent Kaplan-Meier and Cox regression analyses. From November 2002 to November 2004, intravenous immunoglobulin therapy (IVIG) was administered to patients with PCR-positive EMBs. The outcomes of the IVIG-treated, PCR-positive patients (n = 20) were compared with IVIG-untreated, PCR-positive patients (n = 17). Results Viral genomes were detected in EMBs from 37 (39%) patients; parvovirus B19, adenovirus, and Epstein-Barr virus (EBV) were the most common. The PCR-positive group (n = 37, 25% graft loss at 2.4 years) had decreased graft survival (p < 0.001) compared with the PCR-negative group (n = 57, 25% graft loss at 8.7 years) and developed advanced TCAD prematurely (p = 0.001). The number of AR episodes was similar in both groups. On multivariate analysis, presence of viral genome was an independent risk factor for graft loss (relative risk: 4.2, p = 0.015). The time to advanced TCAD after becoming PCR-positive was longer in the IVIG-treated patients (p = 0.03) with a trend toward improved graft survival (p = 0.06). Conclusions Viral endomyocardial infection is an independent predictor of graft loss in pediatric cardiac transplant recipients. This effect appears to be mediated through premature development of advanced TCAD. IVIG therapy in this subgroup may improve survival and merits further investigation. This study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. Viral myocardial infection causes heart failure, but its role after cardiac transplantation is unclear. We hypothesized that viral infection of the cardiac allograft reduces graft survival. Between June 1999 and November 2004, 94 pediatric cardiac transplant patients were screened for the presence of viral genome in serial endomyocardial biopsies (EMBs) using polymerase chain reaction (PCR) assays. Graft loss, advanced transplant coronary artery disease (TCAD), and acute rejection (AR) were compared in the PCR-positive (n = 37) and PCR-negative (n = 57) groups, using time-dependent Kaplan-Meier and Cox regression analyses. From November 2002 to November 2004, intravenous immunoglobulin therapy (IVIG) was administered to patients with PCR-positive EMBs. The outcomes of the IVIG-treated, PCR-positive patients (n = 20) were compared with IVIG-untreated, PCR-positive patients (n = 17). Viral genomes were detected in EMBs from 37 (39%) patients; parvovirus B19, adenovirus, and Epstein-Barr virus (EBV) were the most common. The PCR-positive group (n = 37, 25% graft loss at 2.4 years) had decreased graft survival (p < 0.001) compared with the PCR-negative group (n = 57, 25% graft loss at 8.7 years) and developed advanced TCAD prematurely (p = 0.001). The number of AR episodes was similar in both groups. On multivariate analysis, presence of viral genome was an independent risk factor for graft loss (relative risk: 4.2, p = 0.015). The time to advanced TCAD after becoming PCR-positive was longer in the IVIG-treated patients (p = 0.03) with a trend toward improved graft survival (p = 0.06). Viral endomyocardial infection is an independent predictor of graft loss in pediatric cardiac transplant recipients. This effect appears to be mediated through premature development of advanced TCAD. IVIG therapy in this subgroup may improve survival and merits further investigation. OBJECTIVESThis study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. BACKGROUNDViral myocardial infection causes heart failure, but its role after cardiac transplantation is unclear. We hypothesized that viral infection of the cardiac allograft reduces graft survival. METHODSBetween June 1999 and November 2004, 94 pediatric cardiac transplant patients were screened for the presence of viral genome in serial endomyocardial biopsies (EMBs) using polymerase chain reaction (PCR) assays. Graft loss, advanced transplant coronary artery disease (TCAD), and acute rejection (AR) were compared in the PCR-positive (n = 37) and PCR-negative (n = 57) groups, using time-dependent Kaplan-Meier and Cox regression analyses. From November 2002 to November 2004, intravenous immunoglobulin therapy (IVIG) was administered to patients with PCR-positive EMBs. The outcomes of the IVIG-treated, PCR-positive patients (n = 20) were compared with IVIG-untreated, PCR-positive patients (n = 17). RESULTSViral genomes were detected in EMBs from 37 (39%) patients; parvovirus B19, adenovirus, and Epstein-Barr virus (EBV) were the most common. The PCR-positive group (n = 37, 25% graft loss at 2.4 years) had decreased graft survival (p < 0.001) compared with the PCR-negative group (n = 57, 25% graft loss at 8.7 years) and developed advanced TCAD prematurely (p = 0.001). The number of AR episodes was similar in both groups. On multivariate analysis, presence of viral genome was an independent risk factor for graft loss (relative risk: 4.2, p = 0.015). The time to advanced TCAD after becoming PCR-positive was longer in the IVIG-treated patients (p = 0.03) with a trend toward improved graft survival (p = 0.06). CONCLUSIONSViral endomyocardial infection is an independent predictor of graft loss in pediatric cardiac transplant recipients. This effect appears to be mediated through premature development of advanced TCAD. IVIG therapy in this subgroup may improve survival and merits further investigation. |
Author | Bowles, Karla R., PhD Rossano, Joseph W., MD O'Brian Smith, E., PhD Price, Jack F., MD Moffett, Brady S., PharmD Denfield, Susan W., MD Towbin, Jeffrey A., MD Moulik, Mousumi, MD Kim, Jeffrey J., MD Jefferies, John Lynn, MD, MPH Breinholt, John P., MD Dreyer, William J., MD Bowles, Neil E., PhD Kearney, Debra L., MD Clunie, Sarah K., RN |
AuthorAffiliation | 1 Department of Pediatrics (Cardiology), University of Texas Health Sciences Center, Houston, TX 5 Department of Pharmacy (Texas Children's Hospital), Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA 9 Department of Pediatrics (Cardiology) and The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 8 Department of Pediatrics (Cardiology), University of Utah School of Medicine, Salt Lake City, UT 7 Myriad Genetic Laboratories, Salt Lake City, UT 2 Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, IN 4 Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA 6 Department of Children's Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA 3 Department of Pediatrics (Cardiology), Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA |
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Keywords | graft vasculopathy cardiac transplantation IVIG transplant coronary artery disease virus CMV ISHLT AR acute rejection cytomegalovirus TCAD EBV endomyocardial biopsy International Society of Heart and Lung Transplantation Epstein-Barr virus EMB intravenous immunoglobulin outcome PCR polymerase chain reaction Human Heart Pediatrics Predictor Coronary artery Loss Cardiovascular disease Transplantation Homotransplantation Coronary heart disease Infection Vascular disease Treatment Surgery Viral disease Risk factor Graft Circulatory system Cardiology Predictive factor Child |
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ventricular dysfunction publication-title: Circulation doi: 10.1161/01.CIR.0000072766.67150.51 contributor: fullname: Kuhl |
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Snippet | Objectives This study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. Background Viral... This study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. Viral myocardial infection causes... OBJECTIVESThis study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. BACKGROUNDViral myocardial... Objectives - This study sought to evaluate the outcome and prevalence of viral endomyocardial infection after cardiac transplantation. Background - Viral... |
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SubjectTerms | Adenovirus Adolescent Biological and medical sciences Biopsy cardiac transplantation Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Child Child, Preschool Coronary Disease - virology Coronary heart disease Cytomegalovirus Female Genome, Viral Graft Rejection - virology Graft Survival graft vasculopathy Heart Heart Transplantation Humans Infant Infant, Newborn Infections Infectious diseases Internal Medicine Male Medical sciences Myocarditis - epidemiology Myocarditis - virology outcome Polymerase Chain Reaction Prevalence Risk Factors TCAD Transplants & implants Viral diseases Viral infections virus |
Title | Viral Endomyocardial Infection Is an Independent Predictor and Potentially Treatable Risk Factor for Graft Loss and Coronary Vasculopathy in Pediatric Cardiac Transplant Recipients |
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