Viral infection predicts heart transplant loss in children

August 2, 2010, Cincinnati Children's Hospital Medical Center

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.

Related Stories

Recommended for you

Neuroimaging reveals lasting brain deficits in iron-deficient piglets

February 21, 2018
Iron deficiency in the first four weeks of a piglet's life - equivalent to roughly four months in a human infant - impairs the development of key brain structures, scientists report. The abnormalities remain even after weeks ...

Iron triggers dangerous infection in lung transplant patients, study finds

February 21, 2018
Researchers at the Stanford University School of Medicine have identified elevated tissue iron as a risk factor for life-threatening fungal infections in lung transplant recipients.

Products derived from plants offer potential as dual-targeting agents for experimental cerebral malaria

February 21, 2018
Malaria, a life-threatening disease usually caused when parasites from the Plasmodium family enter the bloodstream of a person bitten by a parasite-carrying mosquito, is a severe health threat globally, with 200 to 300 million ...

Scientists in Germany improve malaria drug production

February 21, 2018
Scientists in Germany who developed a new way to make a key malaria drug several years ago said Wednesday they have come up with a technique to make the process even more efficient, which should increase global access and ...

Early results from clinical trials not all they're cracked up to be, shows new research

February 21, 2018
When people are suffering from a chronic medical condition, they may place their hope on treatments in clinical trials that show early positive results. However, these results may be grossly exaggerated in more than 1 in ...

Clues to obesity's roots found in brain's quality control process

February 20, 2018
Deep in the middle of our heads lies a tiny nub of nerve cells that play a key role in how hungry we feel, how much we eat, and how much weight we gain.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.