Cytomegalovirus and Development of Cardiac Allograft Vasculopathy: Evidences and Therapeutic Implications

Cardiac allograft vasculopathy remains the major cause of long-term failure of heart transplantation. Cytomegalovirus infection was identified as a major risk factor for cardiac allograft vasculopathy development in pioneering studies, even though the possibility that the virus is only an innocent bystander was not completely excluded. Only recently, convincing clinical and experimental evidences support the hypothesis of a direct involvement of cytomegalovirus in cardiac allograft vasculopathy pathogenesis. In this article, we review the mechanisms and clinical evidences supporting the hypothesis that subclinical cytomegalovirus infection leads to adverse long-term graft outcome by favoring cardiac allograft vasculopathy development. In addition, we discuss data pointing to the need for antiviral approaches designed to suppress subclinical cytomegalovirus activation as a long-term strategy to prevent cardiac allograft vasculopathy and chronic allograft damage. (Trends in Transplant. 2010;4:108-16)