Positive pretransplantation cytomegalovirus serology is a risk factor for cardiac allograft vasculopathy in children
Positive pretransplantation cytomegalovirus serology is a risk factor for cardiac allograft vasculopathy in children
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DOI：
10.1161/circulationaha.106.627570
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发表时间：
2007-04-03
期刊：
影响因子：
37.8
通讯作者：
Aurora, Paul
中科院分区：
文献类型：
--
作者：
Hussain, Tarique;Burch, Michael;Aurora, Paul
背景-巨细胞病毒（CMV）感染被认为是成人移植后冠状动脉疾病的一个原因。本回顾性观察性研究的目的是评估心脏移植后的结果在children.Methods和Results-Risk因素测试的CMV的影响受体年龄，性别和移植前CMV血清学;使用抗CMV预防; CMV感染的移植后证据;和供体CMV血清学。移植传统上根据CMV风险分层为低风险（受体阴性/供体阴性），中等风险（受体阳性）和高风险（受体阴性/供体阳性）。主要结局指标为（1）冠状动脉血管病变的发生，（2）术后早期以外发生的死亡（或移植物丢失），和（3）血管病变导致的死亡（或移植物丢失）。通过比例风险模型进行分析。共有165名儿童接受了心脏移植，移植时的平均年龄为7.8岁（SD 5.6）。32名儿童在移植后有CMV感染的实验室证据，但只有6名儿童出现了CMV疾病或综合征。传统的CMV危险分层与CMV感染相关性良好，但不能预测死亡率、冠状动脉疾病或冠状动脉死亡。相反，受体CMV阳性是所有3项结局指标的唯一独立预测因素：冠状动脉疾病（风险比= 3.6），全因死亡率（部分风险比= 4.1），（危害比= 4.6）。结论-在儿童中，移植前受体CMV状态是发生临床显著血管病变和随后死亡的更有力的预测因子，传统的风险分层。这一现象值得进一步调查。
Background-Cytomegalovirus (CMV) infection has been implicated as a cause of posttransplantation coronary artery disease in adults. The purpose of this retrospective observational study was to evaluate the effect of CMV on outcome after heart transplantation in children.Methods and Results-Risk factors tested were recipient age, sex, and pretransplantation CMV serology; use of anti-CMV prophylaxis; posttransplantation evidence of CMV infection; and donor CMV serology. Transplantations were stratified traditionally according to CMV risk as low risk (recipient negative/donor negative), intermediate risk (recipient positive), and high risk (recipient negative/donor positive). Primary outcome measures were (1) development of coronary artery vasculopathy, (2) mortality (or graft loss) that occurred outside the early postoperative period, and (3) death (or graft loss) due to vasculopathy. Analysis was by proportional hazards modeling. A total of 165 children underwent heart transplantation, with a mean age at transplantation of 7.8 (SD 5.6) years. Thirty-two children had laboratory evidence of CMV infection after transplantation, but only 6 developed CMV disease or syndrome. Traditional CMV risk stratification correlated well with CMV infection but did not predict mortality, coronary artery disease, or coronary death. In contrast, positive recipient CMV was the only independent predictor of all 3 outcome measures: coronary artery disease (hazard ratio = 3.6), all-cause mortality (partial hazard ratio = 4.1), and coronary death (hazard ratio = 4.6).Conclusions-In children, pretransplantation recipient CMV status is a more powerful predictor for the development of clinically significant vasculopathy and subsequent death than traditional risk stratification. This phenomenon warrants further investigation.