Cytomegalovirus infection associated accelerated heart allograft arteriosclerosis may impair the late function of the graft

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Abstract
Cardiac allograft arteriosclerosis is the most important limiting factor of long‐term survival of heart transplant recipients. Several clinical studies have suggested the association between CMV infection and heart allograft arteriosclerosis, chronic rejection. To determine the temporal impact of CMV infection on the development of heart allograft arteriosclerosis we quantitated coronary angiograms obtained from 72 heart transplant recipients followed for 1‐6 yr post‐transplantation. To examine the graft function, echocardiography was evaluated. CMV infection was associated with early development of allograft arteriosclerosis manifested by intense diffuse pruning of the coronary arteries including their smallest branches already after the second post‐transplant year. Even 6 yr post‐transplantation the magnitude of arteriosclerotic changes was significantly higher in recipients with CMV infection compared with patients without infection (P<0.02). No difference in echocardiographic parameters including ejection fraction (EF), left ventricular end diastolic diameter (LVEDD) and left ventricular mass (LVM) between recipients with and without CMV infection was recorded early after transplantation. However, when compared to recipients without CMV, the CMV accelerated chronic rejection seen in coronary angiography associated with impaired late graft function as judged by decreased EF in patients with CMV infection 6 yr post‐transplantation (P<0.02). No differences in LVEDD or LVM between the patient groups occurred. Taken together, these results suggest that CMV infection is associated with intense cardiac allograft arteriosclerosis affecting the whole coronary tree soon after transplantation. The intensity and magnitude of these chronic vascular wall changes increase and persist during subsequent years, indicating that the risk for graft loss and death due to chronic rejection is especially high during the first 5 post‐transplant years in CMV‐infected patients. Echocardiography may not be a sensitive method to distinguish patients with early CMV‐accelerated allograft arteriosclerosis but coronary angiography must be performed.