High prevalence of cardiotropic viruses in myocardial tissue from explanted hearts of heart transplant recipients and heart donors:: A 3-year retrospective study from a German patients' pool

Background: The prevalence of some cardiotropic viruses in virus-associated inflammatory cardiac disease remains controversial. The aim of this study was to examine myocardial tissue samples from explanted hearts of heart transplant recipients and heart donors for nucleic acids of myocardiotropic viruses and to observe the potential risk of viral-induced post-transplantation complications in recipients of cardiac allografts or heart valve homografts. Methods: Myocardial tissue samples were analyzed by polymerase chain reaction (PCR) for enteroviruses, adenoviruses, human cytomegalovirus (HCMV), parvovirus B 19 (PVB19), and influenza viruses. The results were compared with serologic and histopathologic findings. Results: PCR analysis of 449 myocardial tissue samples from explanted hearts indicated infection in 34 (47%) of 73 heart transplant recipients and 48 (60%) of 80 donors. The prevalence of virus infection in donors aged over 65 years was significantly higher than in heart transplant recipients (P = 0.005) or donors aged under 65 years (p = 0.02). The most frequently detected viruses were enteroviruses (group B coxsackievirus) and adenoviruses. HCMV and PVB19 were found less frequently. All samples were negative for influenza viruses. Although the serologic findings and PCR results for different viruses were discordant in 4% to 27% of cases, PCR and histopathologic findings were highly correlated (88%). Conclusions: The frequent. detection of viral genome sequences in myocardial tissue of both heart transplant recipients and heart donors suggests a significant risk for graft-transmitted viral infection in cardiac and heart valve transplant recipients.