Effect of infectious diseases on outcome after heart transplant.

Abstract

OBJECTIVE:

To determine how often cardiac allograft recipients develop infectious diseases and how the infections affect these patients.

PATIENTS AND METHODS:

We retrospectively studied 313 patients who underwent heart transplant at Mayo Clinic's site in Rochester, MN, from January 1, 1988, through June 30, 2006.

RESULTS:

In the early postoperative period (ie, period between heart transplant and discharge from the hospital), infectious diseases occurred in 70 (22%) of 313 patients but were not associated with 1-year mortality; the most commonly infected sites were the lungs (7%), bloodstream (6%), upper respiratory tract (5%), and urinary tract (4%). In the 18 years after transplant, the cumulative incidence of infectious diseases was 93%; the most common infectious complications were skin and soft tissue (63%), urinary tract (46%), cytomegalovirus (40%), lung (36%), upper respiratory tract (23%), and varicella zoster virus (15%) infections. After adjustment for baseline predictors, lung (hazard ratio [HR], 3.87; 95% confidence interval [CI], 2.49-6.02; P less than .001) and central nervous system (HR, 4.48; 95% CI, 1.75-11.46; P equals .002) infections were predictive of mortality. Serum creatinine levels (HR, 1.74; 95% CI, 1.07-2.81; P equals .02) and sirolimus use (HR, 2.72; 95% CI, 1.00-7.36; P equals .05) were predictive of lung infection. Death occurred during the study period in 95 (30%) of 313 patients, with a cumulative incidence of 71% at 18 years. The cause of death was infection in 17 (18%) of 95 patients.

CONCLUSION:

Early postoperative infectious complications are frequent in cardiac allograft recipients but are not associated with 1-year mortality. Lung and central nervous system infections are predictors of mortality.

• Authors: Diederik van de Beek, Walter K Kremers, Jose L Del Pozo, Richard C Daly, Brooks S Edwards, Christopher G A McGregor, Robin Patel
• Journal: Mayo Clinic proceedings (Mayo Clin Proc) Vol. 83 Issue 3 Pg. 304-8 (Mar 2008) ISSN: 0025-6196 [Print] England
• PMID: 18315996 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Confidence Intervals
• Female
• Follow-Up Studies
• Heart Failure (surgery)
• Heart Transplantation
• Humans
• Incidence
• Infections (epidemiology, etiology)
• Male
• Middle Aged
• Minnesota (epidemiology)
• Prognosis
• Retrospective Studies
• Risk Factors
• Surgical Wound Infection (epidemiology, etiology)
• Survival Rate
• Time Factors