The influence of cytomegalovirus infection, confirmed by pp65 antigen presence, on the development of cardiac allograft vasculopathy.
OBJECTIVE
We sought to determine the impact of cytomegalovirus (CMV) infection on cardiac allograft vasculopathy (CAV) development in the long term after orthotopic heart transplantation (OHT).


METHODS
We enrolled 144 patients in this retrospective study including 128 men with an overall age at transplantation of 48.4 +/- 9.3 years. Before OHT, 45% exhibited ischemic heart disease (IHD). The mean follow-up was 62 months. Detection of CMV antigenemia was performed by identification of pp65-antigen on peripheral blood leukocytes. The first diagnostic coronary angiography was routinely performed at 1 year after heart transplantation and thence every second year. We evaluated every incidence of change in the coronary arteries, of significant stenosis (requiring percutaneous coronary intervention), acute myocardial infarction, of death or of transplantation. All patients were followed to the incidence of a cardiovascular event, death, or the end of observation.


RESULTS
Of 144 patients, 33 were pp65 positive, namely 29 men with overall mean age at transplantation of 48 +/- 10.3 years. Before OHT, 52% had IHD. The incidence of CAV during follow-up was 24% (n = 8) in the pp65(+) and 22% (n = 24) in the pp65(-) group. It was significant in 3 (9%) versus 8 (24%) patients. There were 4 (12%) deaths in pp65(+) and 9 (8%) deaths in the pp65(-) groups. Kaplan-Meier survival curves to estimate the time for CAV development and death showed no significant differences by log-rank tests.


CONCLUSIONS
No impact of CMV infection on CAV development was observed in first 5 years after OHT.
Zakliczyński
M
M
Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland. zaklimed@onet.pl
Krynicka-Mazurek
A
A
Pyka
Ł
Ł
Trybunia
D
D
Nadziakiewicz
P
P
Przybylski
R
R
Zembala
M
M
D000328:Adult; D003327:Coronary Disease / Q000453:epidemiology; D003331:Coronary Vessels / Q000473:pathology; D003586:Cytomegalovirus Infections / Q000097:blood / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood*; D011183:Postoperative Complications / Q000453:epidemiology / Q000821:virology; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D014184:Transplantation, Homologous; D014763:Viral Matrix Proteins / Q000097:blood*
D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa