FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 344:1498-1503 May 17, 2001 Number 20 Next

	Full Text PDF Editorial by Avery, R. K. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The survival of recipients of cardiac allografts is limited by rejection and coronary vasculopathy. The purpose of this study in children who had received heart transplants was to evaluate the cardiac allografts for myocardial viral infections and to determine whether the presence of viral genome in the myocardium correlates with rejection, coronary vasculopathy, or graft loss.

Methods We enrolled heart-transplant recipients 1 day to 18 years old who were undergoing evaluation for possible rejection and coronary vasculopathy. Endomyocardial-biopsy specimens were evaluated for evidence of rejection with the use of standard criteria and were analyzed for the presence of virus by the polymerase chain reaction (PCR).

Results PCR analyses were performed on 553 consecutive biopsy samples from 149 transplant recipients. Viral genome was amplified from 48 samples (8.7 percent) from 34 patients (23 percent); adenovirus was found in 30 samples, enterovirus in 9 samples, parvovirus in 5 samples, cytomegalovirus in 2 samples, herpes simplex virus in 1 sample, and Epstein–Barr virus in 1 sample. In 29 of the 34 patients with positive results on PCR (85 percent), an adverse cardiac event occurred within three months after the positive biopsy, and 9 of the 34 patients had graft loss due to coronary vasculopathy, chronic graft failure, or acute rejection. In 39 of the 115 patients with negative results on PCR (34 percent), an adverse cardiac event occurred within three months of the negative PCR finding; graft loss did not occur in any of the patients in this group. The odds of graft loss were 6.5 times as great among those with positive results on PCR (P=0.006). The detection of adenovirus was associated with considerably reduced graft survival (P=0.002).

Conclusions Identification of viral genome, particularly adenovirus, in the myocardium of pediatric transplant recipients is predictive of adverse clinical events, including coronary vasculopathy and graft loss.

Source Information

From the Department of Pediatrics (Cardiology), Medical University of South Carolina, Charleston (G.S.S.); the Departments of Pediatrics (Cardiology) (J.N., N.E.B., J.A.T.), Molecular and Human Genetics (J.A.T.), and Cardiovascular Sciences (J.A.T.), Baylor College of Medicine and Texas Children's Hospital, Houston; the Departments of Ambulatory Pediatrics (R.E.C.) and Nursing (J.K.J.), Loma Linda University Children's Hospital, Loma Linda, Calif.; and the Department of Pediatrics (Cardiology), University of Washington, Seattle (G.L.R.).

Address reprint requests to Dr. Towbin at the Department of Pediatric Cardiology, Rm. 333E, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, or at jtowbin{at}bcm.tmc.edu.

Full Text of this Article

This article has been cited by other articles:

• Garnett, C. T., Talekar, G., Mahr, J. A., Huang, W., Zhang, Y., Ornelles, D. A., Gooding, L. R. (2009). Latent Species C Adenoviruses in Human Tonsil Tissues. J. Virol. 83: 2417-2428 [Abstract] [Full Text]  
• Comar, M, D'Agaro, P, Campello, C, Poli, A, Breinholt, J P III, Towbin, J A, Vatta, M (2009). Human herpes virus 6 in archival cardiac tissues from children with idiopathic dilated cardiomyopathy or congenital heart disease. J. Clin. Pathol. 62: 80-83 [Abstract] [Full Text]  
• Nichols, W. G., Peck Campbell, A. J., Boeckh, M. (2008). Respiratory Viruses Other than Influenza Virus: Impact and Therapeutic Advances. Clin. Microbiol. Rev. 21: 274-290 [Abstract] [Full Text]  
• Cooper, L. T., Baughman, K. L., Feldman, A. M., Frustaci, A., Jessup, M., Kuhl, U., Levine, G. N., Narula, J., Starling, R. C., Towbin, J., Virmani, R. (2007). The role of endomyocardial biopsy in the management of cardiovascular disease: A Scientific Statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 28: 3076-3093 [Full Text]  
• Cooper, L. T., Baughman, K. L., Feldman, A. M., Frustaci, A., Jessup, M., Kuhl, U., Levine, G. N., Narula, J., Starling, R. C., Towbin, J., Virmani, R. (2007). The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol 50: 1914-1931 [Full Text]  
• Cooper, L. T., Baughman, K. L., Feldman, A. M., Frustaci, A., Jessup, M., Kuhl, U., Levine, G. N., Narula, J., Starling, R. C., Towbin, J., Virmani, R., Endorsed by the Heart Failure Society of America a, (2007). The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 116: 2216-2233 [Full Text]  
• Potena, L., Holweg, C. T. J., Vana, M. L., Bashyam, L., Rajamani, J., McCormick, A. L., Cooke, J. P., Valantine, H. A., Mocarski, E. S. (2007). Frequent Occult Infection with Cytomegalovirus in Cardiac Transplant Recipients despite Antiviral Prophylaxis. J. Clin. Microbiol. 45: 1804-1810 [Abstract] [Full Text]  
• Webber, S. A. (2007). Cytomegalovirus Infection and Cardiac Allograft Vasculopathy in Children. Circulation 115: 1701-1702 [Full Text]  
• Mikols, C. L., Yan, L., Norris, J. Y., Russell, T. D., Khalifah, A. P., Hachem, R. R., Chakinala, M. M., Yusen, R. D., Castro, M., Kuo, E., Patterson, G. A., Mohanakumar, T., Trulock, E. P., Walter, M. J. (2006). IL-12 p80 Is an Innate Epithelial Cell Effector That Mediates Chronic Allograft Dysfunction. Am. J. Respir. Crit. Care Med. 174: 461-470 [Abstract] [Full Text]  
• Perreau, M., Kremer, E. J. (2005). Frequency, Proliferation, and Activation of Human Memory T Cells Induced by a Nonhuman Adenovirus. J. Virol. 79: 14595-14605 [Abstract] [Full Text]  
• Burch, M (2004). Immune suppressive treatment in paediatric myocarditis: still awaiting the evidence. Heart 90: 1103-1104 [Full Text]  
• Donoso Mantke, O., Meyer, R., Prosch, S., Niedrig, M. (2004). Frequent Detection of Viral Nucleic Acids in Heart Valve Tissue. J. Clin. Microbiol. 42: 2298-2300 [Abstract] [Full Text]  
• Keller, T. T, Mairuhu, A. T.A, de Kruif, M. D, Klein, S. K, Gerdes, V. E.A, ten Cate, H., Brandjes, D. P.M, Levi, M., van Gorp, E. C.M (2003). Infections and endothelial cells. Cardiovasc Res 60: 40-48 [Abstract] [Full Text]  
• Frustaci, A., Chimenti, C., Calabrese, F., Pieroni, M., Thiene, G., Maseri, A. (2003). Immunosuppressive Therapy for Active Lymphocytic Myocarditis: Virological and Immunologic Profile of Responders Versus Nonresponders. Circulation 107: 857-863 [Abstract] [Full Text]  
• Griffin, D. W., Donaldson, K. A., Paul, J. H., Rose, J. B. (2003). Pathogenic Human Viruses in Coastal Waters. Clin. Microbiol. Rev. 16: 129-143 [Abstract] [Full Text]  
• Bowles, N. E., Ni, J., Marcus, F., Towbin, J. A. (2002). The detection of cardiotropic viruses in the myocardium of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol 39: 892-895 [Abstract] [Full Text]  
• Brewer, L. A., Lwamba, H. C. M., Murtaugh, M. P., Palmenberg, A. C., Brown, C., Njenga, M. K. (2001). Porcine Encephalomyocarditis Virus Persists in Pig Myocardium and Infects Human Myocardial Cells. J. Virol. 75: 11621-11629 [Abstract] [Full Text]  
• Avery, R. K. (2001). Viral Triggers of Cardiac-Allograft Dysfunction. NEJM 344: 1545-1547 [Full Text]