Molina Kimberly, Denfield Susan, Fan Yuxin, Moulik Mousumi, Towbin Jeffrey, Dreyer William, Rossano Joseph
Department of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America.
Cardiol Young. 2014 Apr;24(2):331-6. doi: 10.1017/S1047951113000425. Epub 2013 May 17.
Viral genome in cardiac allograft has been associated with early graft loss in children who have undergone cardiac transplant from unknown mechanisms.
This study is a retrospective review of children who have undergone cardiac transplant at a single institution from 1/2004 to 5/2008. Patients underwent cardiac catheterisations with endomyocardial biopsies to evaluate for rejection--graded on Texas Heart Institute scale--and the presence of virus by polymerase chain reaction. Patients with virus identified during the first year post transplant were compared at 1 year post transplant with virus-free patients.
The cohort comprised 59 patients, and the median age at transplant was 5.1 years. Viral genomes were isolated from 18 (31%) patients. The PCR + group had increased inflammation on endomyocardial biopsies, with a median score of 4 (ISHLT IR) versus 1 (ISHLT 1R) in the PCR--group (p = 0.014). The PCR + group had a similar cardiac index (median 3.7 ml/min/m(2)), pulmonary capillary wedge pressure (median 10 mmHg), and pulmonary vascular resistance index (median 1.7 U m(2)) comparatively. PCR + patients were more likely to have experienced an episode of rejection (p = 0.004).
Children who developed viral endomyocardial infections after a cardiac transplant have increased allograft inflammation compared with virus-free patients. However, the haemodynamic profile is similar between the groups. The ongoing subclinical inflammation may contribute to the early graft loss associated with these patients.
心脏移植受者的病毒基因组与儿童心脏移植早期移植物丢失有关，但其机制尚不清楚。
本研究回顾性分析了2004年1月至2008年5月在单一机构接受心脏移植的儿童。患者接受心内膜心肌活检的心脏导管检查，以评估排斥反应（根据德克萨斯心脏研究所标准分级）以及通过聚合酶链反应检测病毒的存在情况。将移植后第一年检测出病毒的患者与未感染病毒的患者在移植后1年进行比较。
该队列包括59例患者，移植时的中位年龄为5.1岁。从18例（31%）患者中分离出病毒基因组。PCR阳性组心内膜心肌活检的炎症反应增加，中位评分为4分（国际心脏和肺移植学会中度排斥反应），而PCR阴性组为1分（国际心脏和肺移植学会轻度排斥反应）（p = 0.014）。相比之下，PCR阳性组的心脏指数（中位值3.7 ml/min/m²）、肺毛细血管楔压（中位值10 mmHg）和肺血管阻力指数（中位值1.7 U m²）相似。PCR阳性患者更有可能经历过一次排斥反应（p = 0.004）。
与未感染病毒的患者相比，心脏移植后发生病毒性心内膜感染的儿童移植物炎症反应增加。然而，两组之间的血流动力学特征相似。持续的亚临床炎症可能导致这些患者出现早期移植物丢失。
