Viral infection predicts heart transplant loss in children

Aug 02, 2010

Scientists report that viral infection of the heart is a predictor of heart transplant failure in young children and adolescents, although it can be detected by screening for viral genes and treated to improve organ survival.

Published online Aug. 2 (Aug. 10 issue) in the , the study suggests a therapeutic strategy for overcoming one of the major challenges facing young heart transplant recipients - that of caused by viral infection.

"We show that viral infection of the heart, specifically due to parvovirus B19, is common in pediatric cardiac transplant recipients and is an independent risk factor for graft loss," said Jeffrey A. Towbin, M.D., executive co-director of the Heart Institute at Cincinnati Children's Hospital Medical Center and senior author. "This effect on graft loss seems to be caused by premature development of advanced transplant coronary artery disease."

Based on a retrospective analysis of pediatric heart transplant patient data showing possible benefits, the researchers recommend investigating the merits of rigorously screening transplant patients for and RNA to detect infection. The greatest infection risk is in the first year after transplant when immune system suppression is most severe. The research team also suggests using intravenous immunoglobulin therapy (IVIG) as a way to prevent heart graft failure. IVIG is a protein therapy designed to boost the immune system and fight infection.

As the prevalence of heart disease and failure increases in the developed world, so does the use of heart transplant as the primary therapy for end-stage disease. Unfortunately, long-term survival rates following heart transplant remain relatively unchanged over the past decade, according to Dr. Towbin and his colleagues. Although the major risk factors for heart graft loss are known, most cannot be addressed medically. Organ loss triggered by viral infection appears to be an exception, the researchers explain.

The study analyzed data from 94 pediatric heart transplant patients ranging in age from less than 1 year to18 years old.

Heart biopsies from the patients were analyzed and screened for viral genes by using polymerase chain reaction (PCR) assays. The assays amplify and detect DNA and RNA sequences that indicate the presence of specific micro-organisms.

Viral genes were detected in the biopsies of 37 patients, with parvovirus B19, adenovirus and Epstein-Barr virus being the most common. Twenty-five percent of these virus-positive patients experienced heart graft loss at 2.4 years, as well as advanced transplant coronary artery disease. Among the 54 patients whose heart biopsies did not detect viral genes, 25 percent experienced heart graft loss at 8.7 years. The heart rejection rate in both groups was similar.

The researchers also studied data comparing heart graft survival and the onset of advanced transplant in 20 virus-positive patients who received IVIG treatment, and in 17 patients who did not. It took longer for patients who received treatment to develop disease and their heart grafts had longer survival times. Three-year graft survival in the IVIG-treated group was 86 percent compared to 33 percent in patients not treated.

All of the heart transplant recipients in the study had received standard post-procedure anti-infection therapies, underscoring the need to screen post-transplant for viral genes and infection and to test new therapeutic interventions.

Researchers note the study was limited by its retrospective design, the relatively small number of patient events and other factors, highlighting the need for further investigation.

Explore further: Dimly lit working environments: Correcting your body clock is possible

add to favorites email to friend print save as pdf

Related Stories

Blood test could show transplant rejection

Dec 25, 2006

A blood test may replace invasive biopsies that heart transplant patients in the United States and elsewhere undergo to check for rejection, heart experts say.

Gene test shown to measure heart function after transplant

Mar 27, 2007

New research suggests a genomic test may provide detailed information on how well a transplanted heart is performing. The gene expression profiling (GEP) test, known as the Allomap® test, is currently used to detect the ...

Heart test found safe for pre-transplant kidney patients

Oct 15, 2009

A screening test that measures whether a patient's heart is healthy enough for a kidney transplant is not as dangerous as once thought, according to a study appearing in an upcoming issue of the Clinical Journal of the Am ...

Recommended for you

Breakthrough in understanding of important blood protein

2 hours ago

The human body contains a unique protein that has the unusual property of destroying itself after a few hours of existence - it must therefore be continually recreated and is no stable protein. The protein, ...

Key to aging immune system is discovered

3 hours ago

There's a good reason people over 60 are not donor candidates for bone marrow transplantation. The immune system ages and weakens with time, making the elderly prone to life-threatening infection and other ...

Putting a number on pain

3 hours ago

"How much pain are you in?" It's a harder question than many people think. Tools for assessing patients' pain—be they children or adults—rely on perception: a subjective measure that eludes quantification ...

New infections cause dormant viruses to reactivate

4 hours ago

The famous slogan is "A diamond is forever," but that phrase might be better suited to herpes: Unlike most viruses, which succumb to the immune system's attack, herpes remains in the body forever, lying in wait, sometimes ...

User comments : 0