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(Circulation. 2007;115:1701-1702.)
© 2007 American Heart Association, Inc.

Editorial

Cytomegalovirus Infection and Cardiac Allograft Vasculopathy in Children

Steven A. Webber, MBChB, MRCP

From the Division of Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa.

Correspondence to Steven A. Webber, MBChB, Division of Cardiology, Children’s Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213. E-mail steve.webber@chp.edu

Key Words: Editorials • grafting • immune system • transplantation • viruses

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The relationship between viral infections, host immune responses, and long-term cardiac allograft outcomes is complex and not fully elucidated at this time.¹ Children are exposed to many viruses, and young transplant recipients will often experience their primary infection for a given viral pathogen while under iatrogenic immunosuppression. Despite this, most viruses cause only mild clinical illness, and transplant recipients often clear infection in a fashion similar to that of their healthy (nonimmunocompromised) peers. Death or serious morbidity from acute viral infection, especially those caused by common respiratory and intestinal viruses, is very rare in children who have received heart transplants. Serious morbidity and mortality may, however, follow infection with human herpes viruses.

Article p 1798

Human herpes virus infections occur in most children during the course of childhood, and the viruses persist in the body indefinitely. Many primary infections carry no symptoms, and the presence of prior infection is identified through evidence of seroconversion at the time of evaluation for transplantation. Symptomatic disease is more common when primary viral infection occurs in the immunocompromised host. Primary Epstein–Barr virus infection posttransplantation poses significant risk for the development of posttransplantation lymphoproliferative disorders.² Cytomegalovirus (CMV) may also cause severe infection, especially if primary infection occurs in the early weeks or months after transplantation. This risk appears low, however, in the modern era.³ Prevention commonly involves early postoperative use of intravenous ganciclovir and/or oral administration of valganciclovir, with or without immunoglobulin preparations. The length of therapy varies widely between centers. Pretransplantation seropositive status for . . . [Full Text of this Article]