Determinants of Cardiovascular Mortality After Renal Transplantation: A Role For Cytomegalovirus?

Abstract

Death with a functioning graft (DWF) is now the most common cause of late renal transplant failure, with cardiovascular disease its most frequent etiology. In some populations, infection with cytomegalovirus (CMV) increases risk of coronary disease. Few data exist regarding CMV and cardiovascular mortality after renal transplantation. We reviewed charts of 158 adult patients who died more than 90 days after receiving renal allografts and a matched cohort of 143 (of 2398) surviving patients transplanted at the University of Alabama at Birmingham between 1990 and 1998. Only advancing donor and recipient age increased risk of DWF; CMV infection did not. However, of 50 patients who died of cardiovascular causes, 94% were seropositive for CMV, while only 74% of the other 108 deaths occurred in CMV-seropositive patients (p ∞ 0.05). Risk of cardiovascular death was greatest (p ∞ 0.05) in patients with diabetes, advancing age, and CMV seropositivity. In renal transplant recipients, infection with CMV increases risk of death as a result of cardiovascular causes.

Immune activation following cytomegalovirus infection: More important than direct viral effects in cardiovascular disease?

“…In particular, cytomegalovirus has been related to a variety of vascular disorders, e.g., sero-epidemiological studies have demonstrated that prior infection with CMV is a strong independent risk factor for restenosis after coronary atherectomy (Epstein et al, 1996;Zhou et al, 1996a). Also, an increased risk for transplant arteriosclerosis has been shown in CMV-seropositive individuals (Grattan et al, 1989;Kalil et al, 2003). Nevertheless, most attention has been paid to the potential role of CMV in accelerating atherosclerosis.…”

Benefits of Cytomegalovirus Prophylaxis in Solid Organ Transplantation

“…A retrospective study in 2,398 adult renal allograft recipients at a single institution found that CMV infection increased the risk of death resulting from cardiovascular causes (12). Charts of patients who died more than 90 days after receiving a renal allograft (nϭ158) and those of a matched cohort who survived with a functioning allograft (nϭ143) were compared for cardiovascular (myocardial infarction, heart failure, or arrhythmia) and noncardiovascular risk factors.…”

Impact of Immunosuppressive Treatment on Endothelial Biomarkers After Kidney Transplantation

“…During CMV infection, endothelial cells acquire a cytomegalic morphology (36) and can be detached from the vessel wall (36)(37)(38). Moreover, CMV infection increases the risk of coronary disease and of death in transplanted patients (39) and is linked to chronic transplant dysfunction (40 (48,49) that are reflected by higher CEC (50) and EMP levels (51). In addition, EMP (52) …”