Association of viral genomic DNA with heart graft loss

The risks that limit survival after heart transplantation include allograft rejection and coronary vasculopathy. In the May 17 New England Journal of Medicine, Girish Shirali and colleagues report that identification of viral DNA in the myocardium of paediatric transplant recipients is predictive of adverse clinical events, including coronary vasculopathy (N Engl J Med 2001, 344:1498-1503).

Serial PCR analysis was performed prospectively on all myocardial biopsy samples obtained from children who were cardiac-transplant recipients at Loma Linda University Children's Hospital. In 29 of the 34 patients with positive results on PCR (85%), whose samples include DNA from adenovirus, enterovirus, parvovirus, cytomegalovirus, herpes simplex virus or Epstein–Barr virus, 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. The detection of adenovirus was associated with considerably reduced graft survival (p=0.002).

The ...