Persistence of Parvovirus B19 after Heart Transplantation in Dilated Cardiomyopathy Pediatric Patients: Predictor of Coronary Vasculopathy and Graft Loss

Purpose To evaluate if the virus found in the myocardium of dilated cardiomyopathy (DCM) pediatric patients persists in the cardiac allograft after heart transplant (HT), and its prognostic implications. Methods Multiplex polymerase chain reaction (PCR) was used to analyze myocardial samples from 48 DCM patients. Subsequently consecutive endomyocardial biopsy (EMB) samples were analyzed from 44 of the 48 patients who underwent HT for the presence of PVB19 and HHV-6 by immunofluorescent assay and their evaluations for rejections, coronary vasculopathy and graft loss. Results Of the 48 DCM patients, 14 (31.8%) had positive viral PCR results in explanted/autopsy hearts. Among them, PVB19 in 8/48, HHV6 in 4/48, both PVB19 and HHV6 in 1/48, enterovirus in 1, but no adenovirus was found. The K-M survival comparison between the patients who were PCR positive for PVB19 versus HHV-6 in the myocardium pre-transplant showed, those with PVB19 had a trend towards a higher graft loss (p=0.05, Fig 1 ) . The EMB samples after HT were positive for PVB19 and HHV-6 in 7/44 and 3/44, respectively. Three of those PVB19 and one HHV-6 were persistence of the virus in their cardiac allografts ( Fig 2 ). There was no significant difference in acute rejections, however coronary vasculoapthy and graft loss were more common (3/7(42.8%) in patients with PVB19 positive versus 5/37(13.5%) PVB19 negative)(Relative risk= 13.5%, Odds ratio= 4.8%). Conclusion The persistence of the PVB19 can occur in the cardiac allograft and is predictive of adverse clinical events, including coronary vasculopathy and graft loss.