Cytomegalovirus infection status predicts progression of heart-transplant vasculopathy.
BACKGROUND
Transplant vasculopathy (TVP) is the most common cause of death and retransplantation after heart transplantation. Human cytomegalovirus (HCMV) infection has been linked to atherosclerosis and to the development of TVP. A prospective study evaluating the relation between CMV infection and progression of TVP is lacking thus far. The purpose of the present study was to investigate the influence of CMV infection status on the progression of TVP within 1 year.


METHODS
We enrolled 103 consecutive heart-transplant recipients who underwent routine cardiac catheterization and intracoronary ultrasound examination at study entry and after 1 year. Plaque progression determined by quantitative intracoronary ultrasound was used to define the severity of disease at baseline and at 1-year follow-up. At study entry, HCMV infection status was evaluated by immunological assays and reverse-transcriptase polymerase chain reaction (RT-PCR).


RESULTS
HCMV immunoglobulin (Ig)G/IgM seropositivity was found in 34 (33%) of transplant recipients, 11 of whom were HCMV PCR positive. The HCMV-positive group showed more advanced, calcified lesions (64.7% vs. 27.5%, P=0.002), and the maximal plaque thickness was significantly different from the HCMV IgG/IgM-negative group (median [quartile] 1.36 [0.85, 1.88] vs. 1.05 [0.58, 1.34], P=0.02). In a logistic regression model, we demonstrate that HCMV IgG/IgM positivity is a predictor for the progression of TVP independent of cardiovascular risk factors, inflammatory markers, and platelet activation (P=0.038). In addition, HCMV PCR positivity even increases the risk for accelerated TVP (P=0.017) and, consecutively, transplant failure.


CONCLUSIONS
HCMV infection status in transplant patients detects patients with increased risk for transplant failure caused by TVP.
Fateh-Moghadam
Suzanne
S
Medizinische Klinik, Kardiologie, Charité-Campus Virchow, Humboldt Universität zu Berlin, Berlin, Germany.
Bocksch
Wolfgang
W
Wessely
Rainer
R
Jäger
Gundula
G
Hetzer
Roland
R
Gawaz
Meinrad
M
D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000821:virology; D012307:Risk Factors; D012907:Smoking; D013997:Time Factors; D014463:Ultrasonography; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*