Strong Association between Infectious Mononucleosis and Cardiac Allograft Vasculopathy Studying Risk Factors and Viral Infections
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Background
Cardiac Allograft vasculopathy (CAV) is a significant cause of late transplant failure. Using a large database, the study’s objective was to assess traditional and infectious risk factors linked to the occurrence and severity of CAV.
Method
Using the large inpatient sample database (NIS), we evaluated any association between CAV and risk factors and infectious viral agents. Additionally, we assessed the severity of CAV based on the occurrence of revascularizations.
Results
A total of 78,330 heart transplant recipients were identified. CAV was diagnosed in 1,015 patients overall. Patients with CAV had a higher mortality rate (4.4% vs 2.1%, OR: 2.09 CI 1.08-4.03 p=0.03). All known traditional risk factors and baseline characteristics, including gender, race, hypertension, hyperlipidemia, diabetes mellitus, and smoking, were not linked to the existence of CAV, except for being younger (mean age 56 vs 59 years). Furthermore, a history of infectious mononucleosis strongly correlated with CAV (OR:8.9 CI 2.68–29.6 p<0.001). Being younger not only increases the possibility of the development of CAV but also increases the probability of undergoing coronary bypass surgery after a heart transplant. Influenza and other forms of viral infections, such as Cytomegalovirus, did not correlate with the presence of CAV.
Conclusion
Younger age was associated with CAV but no other traditional risk factors. Infectious mononucleosis, the only infectious agent correlating with CAV, had a very high association with CAV, warranting further investigation.
