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Cytomegalovirus infection is associated with cardiac allograft rejection and atherosclerosis
M T Grattan1, C E Moreno-Cabral, V A Starnes
1Department of Cardiovascular Surgery, Stanford University Medical Center, CA 94305.
Insights
Cytomegalovirus (CMV) infection significantly increases cardiac transplant rejection, graft atherosclerosis, and death. This impacts patient survival and graft loss rates, highlighting the need for CMV management in transplant recipients.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Cardiac transplantation is a life-saving procedure.
- Immunosuppression is crucial post-transplant but can increase infection risk.
- Cytomegalovirus (CMV) is a common opportunistic infection in transplant patients.
Purpose of the Study:
- To investigate the impact of cytomegalovirus (CMV) infection on cardiac transplant recipients.
- To assess the association between CMV infection and graft rejection, atherosclerosis, and patient survival.
Main Methods:
- Retrospective study of 301 cardiac transplant recipients from 1980 onwards.
- Patients were categorized into CMV-infected (n=91) and non-CMV-infected (n=210) groups.
- CMV infection diagnosis based on serologic titer rise, tissue inclusion bodies, or positive cultures.
Main Results:
- CMV infection was linked to significantly higher rates of graft rejection.
- Graft atherosclerosis was more severe in patients with CMV infection.
- CMV infection was associated with significantly lower patient survival rates and increased graft loss.
Conclusions:
- CMV infection poses a significant threat to cardiac transplant recipients.
- CMV infection is associated with adverse outcomes including rejection, atherosclerosis, and mortality.
- Effective CMV management strategies are critical for improving long-term outcomes in cardiac transplant recipients.
Abstract:
We studied the effects of cytomegalovirus (CMV) infection on 301 cardiac transplant recipients who were treated during the cyclosporine era of immunosuppression (1980 to the present). These patients received varying combinations of cyclosporine, azathioprine, prednisone, rabbit antithymocyte globulin, and OKT3 as their immunosuppressive therapy. Two hundred ten patients were free of CMV infection (non-CMV group). During the same period CMV infection developed in 91 patients, as manifested by a fourfold IgG serologic titer rise, demonstration of CMV inclusion bodies in tissue, or positive cultures for the virus (CMV group). The rate of graft rejection was significantly higher in the CMV group. Graft atherosclerosis was significantly more severe in the CMV group as judged by angiographic criteria or by pathologic study. Patient survival rates were significantly lower in the CMV group. Death caused by graft atherosclerosis was significantly more common among patients in the CMV group. Finally, the graft loss rate (from either death or retransplantation for atherosclerosis) was significantly greater in the CMV group. These data demonstrate that CMV infection in cardiac transplant recipients is associated with more frequent rejection, graft atherosclerosis, and death.