Coronary artery disease after heart transplantation and its relation to cytomegalovirus☆
Section snippets
Clinical studies
The first suggestion that there was an association between cytomegalovirus and CAV was from the Stanford group, who reported their experience with 301 patients. In 28% of cytomegalovirus-infected patients “severe” coronary obstructive lesions developed, whereas in only 10% of patients not infected with cytomegalovirus, the same degree of CAV developed.9A similar association between cytomegalovirus and CAV has been reported by others.10, 11 In contrast, Balk et el12 failed to find a relation
In vitro/animal studies
Several reports of cytomegalovirus accelerating chronic rejection in the animal model have been reported. Lemstrom et al16 have demonstrated cytomegalovirus to be a chronic rejection–accelerating factor in the aortic allograft model and its inhibition with intensive immunosuppression17 or treatment with gancyclovir.18 In these experiments, cytomegalovirus infection was introduced at the time of transplantation or later after transplantation. Whether pretreatment of the donor or recipient with
Summary
The development of transplantation coronary artery disease clearly requires the allogeneic response, given its limitation to the allograft. Therefore effects of cytomegalovirus on the development of this obliterative vasculopathy cannot be direct but must somehow alter (augment) the primary allogeneic response. Although the endothelial cell does not appear to allow cytomegalovirus viral replication, infection does result in widespread alterations in endothelial cell biology. Alternatively, if
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Is there a relation between transplant coronary artery disease and the occurrence of CMV infection [abstract]?
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Cited by (54)
Cyclosporine Versus Tacrolimus: Which Calcineurin Inhibitor Has Influence on Cytomegalovirus Infection in Cardiac Transplantation?
2018, Transplantation ProceedingsCytomegalovirus
2011, Infectious Diseases of the Fetus and Newborn InfantCytomegalovirus
2010, Infectious Diseases of the Fetus and Newborn: Expert Consult - Online and PrintIndirect effects of cytomegalovirus infection in solid organ transplant recipients
2008, Enfermedades Infecciosas y Microbiologia ClinicaCitation Excerpt :Although these results have not been confirmed in other studies,52 the fact that asymptomatic CMV infection has been associated with a reduction in the survival of kidney transplant recipients may show the importance of preventing asymptomatic viremia even in the presence of low viral replication by administration of universal prophylaxis to all at-risk patients (table 4). Cytomegalovirus infection has been associated with acute rejection and graft vascular remodeling in heart transplant recipients, as well as with accelerated coronary atherosclerosis and endothelial dysfunction.53–55 There are studies showing the role of CMV infection in accelerated vasculopathy in both the general population and heart graft recipients.
Spanish heart transplant units consensus conference
2007, Revista Espanola de Cardiologia SuplementosAcute cytomegalovirus infection and venous thrombosis: Role of antiphospholipid antibodies
2007, Journal of InfectionCitation Excerpt :Some infections by bacteria and viruses have been implicated in atherosclerotic lesions and thrombotic phenomena.1–2 The endothelial damage caused by cytomegalovirus may promote vascular thromboembolisms, especially in patients with compromised immune systems such as persons with AIDS or transplant patients who must take immunosuppressive drugs.3–5 Acute CMV infection in immunocompetent patients is generally asymptomatic or causes symptoms similar to those of infectious mononucleosis: fever, lymphocytosis, and hepatitis.
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