Influence of cytomegalovirus infection in the development of cardiac allograft vasculopathy after heart transplantation
Influence of cytomegalovirus infection in the development of cardiac allograft vasculopathy after heart transplantation
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DOI：
10.1016/j.healun.2015.03.015
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发表时间：
2015-08-01
影响因子：
8.9
通讯作者：
Lumbreras, Carlos
中科院分区：
文献类型：
--
作者：
Delgado, Juan F.;Garcia Reyne, Ana;Lumbreras, Carlos
背景技术背景：心脏移植物血管病变（CAV）是心脏移植术后长期发病和死亡的主要原因，其与CMV感染的关系尚不清楚。本研究评估CMV感染的影响，在CAV的发展。方法：我们招募了166个连续HTx接受者进行了首次移植，从1995年1月至2002年7月。所有患者接受14天的静脉注射更昔洛韦，并在HTx后的第一年前瞻性监测CMV感染。根据国际心肺移植学会的新标准，在HTx后1年、5年和10年进行冠状动脉造影诊断CAV。我们收集了所有可能与CAV发展相关的变量。结果：随访1-17年，中位随访11年，72例（43%）发生CAV（1例63.8%，2例15.2%，3例20.8%）。32%的患者出现继发于CAV的症状，8%的患者因此死亡。在多元回归分析中，与CAV发生相关的自变量是供者年龄（风险比[fin 1.028; 95%置信区间[CI]，1.002-1.053; p < 0.028），存在细胞急性排斥反应>= 2 R（HR，1.764; 95% CI，1.011-3.078; p < 0.0414），CMV感染（HR，2.334; 95% CI，1.043- 5.225; p <0.0354），且未接受钙通道阻滞剂治疗结论：标准化的血管造影标准显示CMV感染与CAV的发生有关。(C)2015年国际心肺移植学会。All rights reserved.
BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major cause of long-term morbidity and mortality after heart transplantation (HTx), whose relationship with CMV infection is uncertain. This study evaluated the influence of CMV infection in the development of CAV.METHODS: We enrolled 166 consecutive HTx recipients who underwent their first transplant from January 1995 to July 2002. All patients received 14 days of intravenous ganciclovir and were prospectively monitored for CMV infection during the first year after HTx. CAV was diagnosed by coronary angiography performed at 1, 5, and 10 years after HTx, following the new criteria of the International Society for Heart and Lung Transplantation. We collected all variables potentially related with the development of CAV. Risk factors were studied using a complementary log-log model.RESULTS: After a median follow-up of 11 years (range, 1-17 years), 72 patients (43%) developed CAV (63.8% CAV(1), 15.2% CAV(2), 20.8% CAV(3)). Symptoms secondary to CAV were present in 32% of these patients, and 8% died because of it. In the regression multivariate analysis, independent variables associated with the development of CAV were donor age (hazard ratio [fin 1.028; 95% confidence interval [CI], 1.002-1.053; p < 0.028), presence of cellular acute rejection >= 2R (HR, 1.764; 95% CI, 1.011-3.078; p < 0.0414), CMV infection (HR, 2.334; 95% CI, 1.043- 5.225; p < 0,0354), and not having been treated with a calcium channel blocker (HR, 0.472; 95% CI, 0.275-0.811; p < 0.0055).CONCLUSIONS: Standardized angiographic criteria show CMV infection is associated with the development of CAV. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.