title: Viral endomyocardial infection in the 1st year post transplant is associated with persistent inflammation in children who have undergone cardiac transplant.
abstract: BACKGROUND
  Viral genome in cardiac allograft has been associated with early graft loss in children who have undergone cardiac transplant from unknown mechanisms.
  
  
  METHODS
  This study is a retrospective review of children who have undergone cardiac transplant at a single institution from 1/2004 to 5/2008. Patients underwent cardiac catheterisations with endomyocardial biopsies to evaluate for rejection--graded on Texas Heart Institute scale--and the presence of virus by polymerase chain reaction. Patients with virus identified during the first year post transplant were compared at 1 year post transplant with virus-free patients.
  
  
  RESULTS
  The cohort comprised 59 patients, and the median age at transplant was 5.1 years. Viral genomes were isolated from 18 (31%) patients. The PCR + group had increased inflammation on endomyocardial biopsies, with a median score of 4 (ISHLT IR) versus 1 (ISHLT 1R) in the PCR--group (p = 0.014). The PCR + group had a similar cardiac index (median 3.7 ml/min/m(2)), pulmonary capillary wedge pressure (median 10 mmHg), and pulmonary vascular resistance index (median 1.7 U m(2)) comparatively. PCR + patients were more likely to have experienced an episode of rejection (p = 0.004).
  
  
  CONCLUSIONS
  Children who developed viral endomyocardial infections after a cardiac transplant have increased allograft inflammation compared with virus-free patients. However, the haemodynamic profile is similar between the groups. The ongoing subclinical inflammation may contribute to the early graft loss associated with these patients.
authors.affiliation: Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Molina
authors.affiliation: Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Denfield
authors.affiliation: Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Mousumi
authors.initials: M
authors.lastname: Moulik
authors.affiliation: Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Towbin
authors.affiliation: Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Dreyer
authors.affiliation: Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rossano
mesh_terms: D001706:Biopsy; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis*; D004699:Endocardium / Q000473:pathology* / Q000821:virology; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000473:pathology* / Q000821:virology; D006321:Heart / Q000821:virology*; D016027:Heart Transplantation; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000150:complications / Q000473:pathology / Q000821:virology; D008297:Male; D009206:Myocardium / Q000473:pathology*; D010322:Parvoviridae Infections / Q000150:complications / Q000473:pathology*; D016732:Parvovirus B19, Human / Q000235:genetics; D012189:Retrospective Studies
chemical_list: D004279:DNA, Viral