Hussain Tarique, Burch Michael, Fenton Matthew J, Whitmore Pauline M, Rees Philip, Elliott Martin, Aurora Paul
Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom.
Circulation. 2007 Apr 3;115(13):1798-805. doi: 10.1161/CIRCULATIONAHA.106.627570. Epub 2007 Mar 12.
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.
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).
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.
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病因。这项回顾性观察研究的目的是评估CMV对儿童心脏移植后结局的影响。
所检测的危险因素包括受者年龄、性别和移植前CMV血清学；抗CMV预防措施的使用；移植后CMV感染的证据；以及供者CMV血清学。传统上根据CMV风险将移植分为低风险（受者阴性/供者阴性）、中度风险（受者阳性）和高风险（受者阴性/供者阳性）。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）；以及（3）因血管病变导致的死亡（或移植物丢失）。采用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（标准差5.6）岁。32名儿童移植后有CMV感染的实验室证据，但只有6名发生了CMV疾病或综合征。传统的CMV风险分层与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。相比之下，受者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）和冠状动脉死亡（风险比=4.6）。
在儿童中，移植前受者的CMV状态比传统风险分层更能有力地预测具有临床意义的血管病变的发生及随后的死亡。这一现象值得进一步研究。
