Association of viral genome with graft loss in children after cardiac transplantation

Girish S. Shirali, Jiyuan Ni, Richard E. Chinnock, Joyce K. Johnston, Geoffrey L. Rosenthal, Neil E. Bowles, Jeffrey Towbin

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Abstract

Background: The survival of recipients of cardiac allografts is limited by rejection and coronary vasculopathy. The purpose of this study in children who had received heart transplants was to evaluate the cardiac allografts for myocardial viral infections and to determine whether the presence of viral genome in the myocardium correlates with rejection, coronary vasculopathy, or graft loss. Methods: We enrolled heart-transplant recipients 1 day to 18 years old who were undergoing evaluation for possible rejection and coronary vasculopathy. Endomyocardial-biopsy specimens were evaluated for evidence of rejection with the use of standard criteria and were analyzed for the presence of virus by the polymerase chain reaction (PCR). Results: PCR analyses were performed on 553 consecutive biopsy samples from 149 transplant recipients. Viral genome was amplified from 48 samples (8.7 percent) from 34 patients (23 percent); adenovirus was found in 30 samples, enterovirus in 9 samples, parvovirus in 5 samples, cytomegalovirus in 2 samples, herpes simplex virus in 1 sample, and Epstein-Barr virus in 1 sample. In 29 of the 34 patients with positive results on PCR (85 percent), an adverse cardiac event occurred within three months after the positive biopsy, and 9 of the 34 patients had graft loss due to coronary vasculopathy, chronic graft failure, or acute rejection. In 39 of the 115 patients with negative results on PCR (34 percent), an adverse cardiac event occurred within three months of the negative PCR finding; graft loss did not occur in any of the patients in this group. The odds of graft loss were 6.5 times as great among those with positive results on PCR (P=0.006). The detection of adenovirus was associated with considerably reduced graft survival (P=0.002). Conclusions: Identification of viral genome, particularly adenovirus, in the myocardium of pediatric transplant recipients is predictive of adverse clinical events, including coronary vasculopathy and graft loss.

Original languageEnglish (US)
Pages (from-to)1498-1503
Number of pages6
JournalNew England Journal of Medicine
Volume344
Issue number20
DOIs
StatePublished - May 17 2001
Externally publishedYes

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Viral Genome
Heart Transplantation
Transplants
Polymerase Chain Reaction
Adenoviridae
Biopsy
Allografts
Myocardium
Parvovirus
Enterovirus
Human Herpesvirus 1
Graft Survival
Virus Diseases
Cytomegalovirus
Human Herpesvirus 4
Pediatrics
Viruses
Survival
Transplant Recipients

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Shirali, G. S., Ni, J., Chinnock, R. E., Johnston, J. K., Rosenthal, G. L., Bowles, N. E., & Towbin, J. (2001). Association of viral genome with graft loss in children after cardiac transplantation. New England Journal of Medicine, 344(20), 1498-1503. https://doi.org/10.1056/NEJM200105173442002

Association of viral genome with graft loss in children after cardiac transplantation. / Shirali, Girish S.; Ni, Jiyuan; Chinnock, Richard E.; Johnston, Joyce K.; Rosenthal, Geoffrey L.; Bowles, Neil E.; Towbin, Jeffrey.

In: New England Journal of Medicine, Vol. 344, No. 20, 17.05.2001, p. 1498-1503.

Research output: Contribution to journalArticle

Shirali, GS, Ni, J, Chinnock, RE, Johnston, JK, Rosenthal, GL, Bowles, NE & Towbin, J 2001, 'Association of viral genome with graft loss in children after cardiac transplantation', New England Journal of Medicine, vol. 344, no. 20, pp. 1498-1503. https://doi.org/10.1056/NEJM200105173442002
Shirali GS, Ni J, Chinnock RE, Johnston JK, Rosenthal GL, Bowles NE et al. Association of viral genome with graft loss in children after cardiac transplantation. New England Journal of Medicine. 2001 May 17;344(20):1498-1503. https://doi.org/10.1056/NEJM200105173442002
Shirali, Girish S. ; Ni, Jiyuan ; Chinnock, Richard E. ; Johnston, Joyce K. ; Rosenthal, Geoffrey L. ; Bowles, Neil E. ; Towbin, Jeffrey. / Association of viral genome with graft loss in children after cardiac transplantation. In: New England Journal of Medicine. 2001 ; Vol. 344, No. 20. pp. 1498-1503.
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abstract = "Background: The survival of recipients of cardiac allografts is limited by rejection and coronary vasculopathy. The purpose of this study in children who had received heart transplants was to evaluate the cardiac allografts for myocardial viral infections and to determine whether the presence of viral genome in the myocardium correlates with rejection, coronary vasculopathy, or graft loss. Methods: We enrolled heart-transplant recipients 1 day to 18 years old who were undergoing evaluation for possible rejection and coronary vasculopathy. Endomyocardial-biopsy specimens were evaluated for evidence of rejection with the use of standard criteria and were analyzed for the presence of virus by the polymerase chain reaction (PCR). Results: PCR analyses were performed on 553 consecutive biopsy samples from 149 transplant recipients. Viral genome was amplified from 48 samples (8.7 percent) from 34 patients (23 percent); adenovirus was found in 30 samples, enterovirus in 9 samples, parvovirus in 5 samples, cytomegalovirus in 2 samples, herpes simplex virus in 1 sample, and Epstein-Barr virus in 1 sample. In 29 of the 34 patients with positive results on PCR (85 percent), an adverse cardiac event occurred within three months after the positive biopsy, and 9 of the 34 patients had graft loss due to coronary vasculopathy, chronic graft failure, or acute rejection. In 39 of the 115 patients with negative results on PCR (34 percent), an adverse cardiac event occurred within three months of the negative PCR finding; graft loss did not occur in any of the patients in this group. The odds of graft loss were 6.5 times as great among those with positive results on PCR (P=0.006). The detection of adenovirus was associated with considerably reduced graft survival (P=0.002). Conclusions: Identification of viral genome, particularly adenovirus, in the myocardium of pediatric transplant recipients is predictive of adverse clinical events, including coronary vasculopathy and graft loss.",
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AU - Shirali, Girish S.

AU - Ni, Jiyuan

AU - Chinnock, Richard E.

AU - Johnston, Joyce K.

AU - Rosenthal, Geoffrey L.

AU - Bowles, Neil E.

AU - Towbin, Jeffrey

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N2 - Background: The survival of recipients of cardiac allografts is limited by rejection and coronary vasculopathy. The purpose of this study in children who had received heart transplants was to evaluate the cardiac allografts for myocardial viral infections and to determine whether the presence of viral genome in the myocardium correlates with rejection, coronary vasculopathy, or graft loss. Methods: We enrolled heart-transplant recipients 1 day to 18 years old who were undergoing evaluation for possible rejection and coronary vasculopathy. Endomyocardial-biopsy specimens were evaluated for evidence of rejection with the use of standard criteria and were analyzed for the presence of virus by the polymerase chain reaction (PCR). Results: PCR analyses were performed on 553 consecutive biopsy samples from 149 transplant recipients. Viral genome was amplified from 48 samples (8.7 percent) from 34 patients (23 percent); adenovirus was found in 30 samples, enterovirus in 9 samples, parvovirus in 5 samples, cytomegalovirus in 2 samples, herpes simplex virus in 1 sample, and Epstein-Barr virus in 1 sample. In 29 of the 34 patients with positive results on PCR (85 percent), an adverse cardiac event occurred within three months after the positive biopsy, and 9 of the 34 patients had graft loss due to coronary vasculopathy, chronic graft failure, or acute rejection. In 39 of the 115 patients with negative results on PCR (34 percent), an adverse cardiac event occurred within three months of the negative PCR finding; graft loss did not occur in any of the patients in this group. The odds of graft loss were 6.5 times as great among those with positive results on PCR (P=0.006). The detection of adenovirus was associated with considerably reduced graft survival (P=0.002). Conclusions: Identification of viral genome, particularly adenovirus, in the myocardium of pediatric transplant recipients is predictive of adverse clinical events, including coronary vasculopathy and graft loss.

AB - Background: The survival of recipients of cardiac allografts is limited by rejection and coronary vasculopathy. The purpose of this study in children who had received heart transplants was to evaluate the cardiac allografts for myocardial viral infections and to determine whether the presence of viral genome in the myocardium correlates with rejection, coronary vasculopathy, or graft loss. Methods: We enrolled heart-transplant recipients 1 day to 18 years old who were undergoing evaluation for possible rejection and coronary vasculopathy. Endomyocardial-biopsy specimens were evaluated for evidence of rejection with the use of standard criteria and were analyzed for the presence of virus by the polymerase chain reaction (PCR). Results: PCR analyses were performed on 553 consecutive biopsy samples from 149 transplant recipients. Viral genome was amplified from 48 samples (8.7 percent) from 34 patients (23 percent); adenovirus was found in 30 samples, enterovirus in 9 samples, parvovirus in 5 samples, cytomegalovirus in 2 samples, herpes simplex virus in 1 sample, and Epstein-Barr virus in 1 sample. In 29 of the 34 patients with positive results on PCR (85 percent), an adverse cardiac event occurred within three months after the positive biopsy, and 9 of the 34 patients had graft loss due to coronary vasculopathy, chronic graft failure, or acute rejection. In 39 of the 115 patients with negative results on PCR (34 percent), an adverse cardiac event occurred within three months of the negative PCR finding; graft loss did not occur in any of the patients in this group. The odds of graft loss were 6.5 times as great among those with positive results on PCR (P=0.006). The detection of adenovirus was associated with considerably reduced graft survival (P=0.002). Conclusions: Identification of viral genome, particularly adenovirus, in the myocardium of pediatric transplant recipients is predictive of adverse clinical events, including coronary vasculopathy and graft loss.

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