Positive pretransplantation cytomegalovirus serology is a risk factor for cardiac allograft vasculopathy in children.
Circulation
; 115(13): 1798-805, 2007 Apr 03.
Article
em En
| MEDLINE
| ID: mdl-17353448
ABSTRACT
BACKGROUND:
Cytomegalovirus (CMV) infection has been implicated as a cause of posttransplantation coronary artery disease in adults. The purpose of this retrospective observational study was to evaluate the effect of CMV on outcome after heart transplantation in children. METHODS ANDRESULTS:
Risk factors tested were recipient age, sex, and pretransplantation CMV serology; use of anti-CMV prophylaxis; posttransplantation evidence of CMV infection; and donor CMV serology. Transplantations were stratified traditionally according to CMV risk as low risk (recipient negative/donor negative), intermediate risk (recipient positive), and high risk (recipient negative/donor positive). Primary outcome measures were (1) development of coronary artery vasculopathy, (2) mortality (or graft loss) that occurred outside the early postoperative period, and (3) death (or graft loss) due to vasculopathy. Analysis was by proportional hazards modeling. A total of 165 children underwent heart transplantation, with a mean age at transplantation of 7.8 (SD 5.6) years. Thirty-two children had laboratory evidence of CMV infection after transplantation, but only 6 developed CMV disease or syndrome. Traditional CMV risk stratification correlated well with CMV infection but did not predict mortality, coronary artery disease, or coronary death. In contrast, positive recipient CMV was the only independent predictor of all 3 outcomemeasures:
coronary artery disease (hazard ratio=3.6), all-cause mortality (partial hazard ratio=4.1), and coronary death (hazard ratio=4.6).CONCLUSIONS:
In children, pretransplantation recipient CMV status is a more powerful predictor for the development of clinically significant vasculopathy and subsequent death than traditional risk stratification. This phenomenon warrants further investigation.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Transplante de Coração
/
Infecções por Citomegalovirus
/
Doença das Coronárias
/
Anticorpos Antivirais
Tipo de estudo:
Etiology_studies
/
Evaluation_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Circulation
Ano de publicação:
2007
Tipo de documento:
Article
País de afiliação:
Reino Unido