The development of arteriosclerosis after heart transplantation plays a major role in decreased graft and patient survival. Although several pathogenic mechanisms have been proposed for the development of posttransplant coronary artery disease (CAD), a significant amount of accumulating evidence suggests that cytomegalovirus is a critical factor in this disease. Because post-transplant CAD is often a silent disease and early detection escapes conventional angiography, physicians must maintain close surveillance of heart transplant patients and institute prophylaxis in high-risk groups. In addition to targeting conventional risk factors, prophylaxis against CMV disease should decrease the incidence of the disease.
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