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Viral endomyocardial infection in the 1st year post transplant is associated with persistent inflammation in children who have undergone cardiac transplant

Published online by Cambridge University Press:  17 May 2013

Kimberly Molina*
Affiliation:
Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
Susan Denfield
Affiliation:
Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
Yuxin Fan
Affiliation:
Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
Mousumi Moulik
Affiliation:
Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
Jeffrey Towbin
Affiliation:
Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
William Dreyer
Affiliation:
Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
Joseph Rossano
Affiliation:
Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
*
Correspondence to: Dr K. Molina, Pediatric Cardiology, University of Utah, 100 N. Mario Capecchi Dr, Ste 1500, Salt Lake City 84113, United States of America. Tel: 801-662-5400; Fax: 801-662-5404; E-mail: kimberly.molina@imail.org

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/m2), pulmonary capillary wedge pressure (median 10 mmHg), and pulmonary vascular resistance index (median 1.7 U m2) 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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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