Lowry R W, Adam E, Hu C, Kleiman N S, Cocanougher B, Windsor N, Bitar J N, Melnick J L, Young J B
Multi-organ Transplant Center, Methodist Hospital, Houston, Texas.
J Heart Lung Transplant. 1994 Jan-Feb;13(1 Pt 1):122-8.
To elucidate prognostic implications of recipient cytomegalovirus infection before heart transplantation, we prospectively followed the clinical outcome of 21 transplant recipients whose explanted hearts (myocardium and coronary arteries) were first examined for the presence of cytomegalovirus DNA with polymerase chain reaction. Subsequently, serial endomyocardial biopsy tissue samples obtained from the allograft during routine evaluation for rejection were analyzed by polymerase chain reaction for both an immediate early and late cytomegalovirus gene region of cytomegalovirus DNA. Humoral cytomegalovirus immunoglobulin G antibodies were also measured by radioimmunoassay. Both early and late antigens were present in 14 of 21 (67%) explants from patients with (12 of 15 explants) and without (2 of 6 explants) pretransplant cytomegalovirus antibodies. Although the presence of both early and late antigens was uncommon in allografts the first week after transplantation (5 of 20 allografts, 25%), their presence significantly increased at 1 month (14 of 21 allografts, 67%) and 2 to 3 months (13 of 17 allografts, 77%) regardless of pretransplantation cytomegalovirus antibody status. The presence of both early and late antigens in explant tissue strongly predicted allograft virus status during the follow-up periods. Of five patients in whom clinical cytomegalovirus disease subsequently developed, all had explants positive for both early and late antigens, and all allografts were positive for early and late antigens within 1 month after transplantation. These are the first prospective data to correlate pretransplantation serum antibodies and explant polymerase chain reaction status with the development of future allograft infections and overall clinical outcome.
为阐明心脏移植前受者巨细胞病毒感染的预后意义，我们前瞻性地追踪了21例移植受者的临床结局，这些受者切除的心脏（心肌和冠状动脉）首先通过聚合酶链反应检测巨细胞病毒DNA的存在情况。随后，在常规排斥反应评估期间从同种异体移植物获取的系列心内膜心肌活检组织样本，通过聚合酶链反应分析巨细胞病毒DNA的即刻早期和晚期基因区域。还通过放射免疫测定法检测体液中的巨细胞病毒免疫球蛋白G抗体。在有（15个外植体中的12个）和无（6个外植体中的2个）移植前巨细胞病毒抗体的患者的21个外植体中，有14个（67%）同时存在早期和晚期抗原。尽管在移植后第一周的同种异体移植物中同时存在早期和晚期抗原并不常见（20个同种异体移植物中有5个，25%），但无论移植前巨细胞病毒抗体状态如何，它们在1个月时（21个同种异体移植物中有14个，67%）和2至3个月时（17个同种异体移植物中有13个，77%）的存在显著增加。外植体组织中早期和晚期抗原的存在强烈预示了随访期间同种异体移植物的病毒状态。在随后发生临床巨细胞病毒疾病的5例患者中，所有患者的外植体早期和晚期抗原均为阳性，且所有同种异体移植物在移植后1个月内早期和晚期抗原均为阳性。这些是将移植前血清抗体和外植体聚合酶链反应状态与未来同种异体移植物感染的发生及总体临床结局相关联的首批前瞻性数据。
