Abstract 2573: Viral Endomyocardial Infection is an Independent Predictor of Graft Loss in Pediatric Cardiac Transplant Recipients
Background: Viral myocardial infection causes heart failure, but its role after cardiac transplantation is unclear. We hypothesized that viral infection of the cardiac allograft reduces graft survival.
Methods: We screened a cohort of 94 pediatric cardiac transplant patients, between 6/99 and 11/04, for the presence of viral genome in serial endomyocardial biopsies (EMB) using PCR assays. Outcomes of graft loss, advanced graft vasculopathy (GV) and acute rejection (AR) were compared in the PCR-positive (PCR+) and PCR-negative (PCR-) groups, using Kaplan-Meier and Cox regression analyses.
Results: Viral genomes were detected in EMB from 37 patients (39%); parvoB19, adeno, and EBV were the most common. Compared to the PCR- group (n=57, median survival 12.4 yrs), the PCR+ group (n=37, median survival 6.2 yrs) had decreased graft survival (p=0.03) and developed advanced GV prematurely (p=0.01). The number of AR episodes was similar in both groups. On multivariate analysis, presence of viral genome was an independent risk factor for graft loss (relative risk 3.3, p=0.03). From 11/02 to 11/04, IVIG therapy had been administered to patients after PCR+ EMBs. In a subgroup analysis, the outcomes of the IVIG-treated PCR+ patients (n=20) were compared with IVIG-untreated PCR+ patients (n=17). The time to advanced GV after becoming PCR+ was longer in the IVIG-treated patients (p=0.03), with a trend towards improved graft survival (p=0.06).
Conclusions: Viral endomyocardial infection is an independent predictor of graft loss and is associated with premature advanced GV in pediatric cardiac transplant recipients. IVIG therapy in this subgroup appears beneficial in improving survival.