Koskinen P, Lemstrøm K, Mattila S, Häyry P, Nieminen M S
Transplantation Laboratory, University of Helsinki, Finland.
Clin Transplant. 1996 Dec;10(6 Pt 1):487-93.
Cardiac allograft arteriosclerosis is the most important limiting factor of long-term survival of heart transplant recipients. Several clinical studies have suggested the association between CMV infection and heart allograft arteriosclerosis, chronic rejection. To determine the temporal impact of CMV infection on the development of heart allograft arteriosclerosis we quantitated coronary angiograms obtained from 72 heart transplant recipients followed for 1-6 yr post-transplantation. To examine the graft function, echocardiography was evaluated. CMV infection was associated with early development of allograft arteriosclerosis manifested by intense diffuse pruning of the coronary arteries including their smallest branches already after the second post-transplant year. Even 6 yr post-transplantation the magnitude of arteriosclerotic changes was significantly higher in recipients with CMV infection compared with patients without infection (P < 0.02). No difference in echocardiographic parameters including ejection fraction (EF), left ventricular end diastolic diameter (LVEDD) and left ventricular mass (LVM) between recipients with and without CMV infection was recorded early after transplantation. However, when compared to recipients without CMV, the CMV accelerated chronic rejection seen in coronary angiography associated with impaired late graft function as judged by decreased EF in patients with CMV infection 6 yr post-transplantation (P < 0.02). No differences in LVEDD or LVM between the patient groups occurred. Taken together, these results suggest that CMV infection is associated with intense cardiac allograft arteriosclerosis affecting the whole coronary tree soon after transplantation. The intensity and magnitude of these chronic vascular wall changes increase and persist during subsequent years, indicating that the risk for graft loss and death due to chronic rejection is especially high during the first 5 post-transplant years in CMV-infected patients. Echocardiography may not be a sensitive method to distinguish patients with early CMV-accelerated allograft arteriosclerosis but coronary angiography must be performed.
心脏移植后同种异体移植物动脉硬化是影响心脏移植受者长期存活的最重要限制因素。多项临床研究表明巨细胞病毒（CMV）感染与心脏移植后同种异体移植物动脉硬化、慢性排斥反应之间存在关联。为了确定CMV感染对心脏移植后同种异体移植物动脉硬化发展的时间影响，我们对72例心脏移植受者移植后1至6年的冠状动脉造影进行了定量分析。为了检查移植心脏功能，我们对超声心动图进行了评估。CMV感染与移植后第二年即出现的冠状动脉严重弥漫性变细（包括最小分支）所表现的同种异体移植物动脉硬化的早期发展相关。即使在移植后6年，CMV感染受者的动脉硬化改变程度仍显著高于未感染患者（P<0.02）。移植后早期，CMV感染和未感染受者之间的超声心动图参数（包括射血分数（EF）、左心室舒张末期内径（LVEDD）和左心室质量（LVM））没有差异。然而，与未感染CMV的受者相比，移植后6年CMV感染患者中通过冠状动脉造影所见的CMV加速慢性排斥反应与移植心脏晚期功能受损相关，表现为EF降低（P<0.02）。两组患者的LVEDD或LVM没有差异。综上所述，这些结果表明CMV感染与移植后不久即影响整个冠状动脉树的严重心脏移植后同种异体移植物动脉硬化相关。这些慢性血管壁改变的强度和程度在随后几年中增加并持续存在，表明在移植后前5年，CMV感染患者因慢性排斥反应导致移植失败和死亡的风险特别高。超声心动图可能不是区分早期CMV加速的同种异体移植物动脉硬化患者的敏感方法，但必须进行冠状动脉造影。
