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. 2015 Feb;34(2):227-32.
doi: 10.1016/j.healun.2014.09.036. Epub 2014 Oct 2.

Risk factors for invasive fungal disease in heart transplant recipients

Alexander S Rabin  1 , Michael M Givertz  2 , Gregory S Couper  3 , Margaret M Shea  4 , Driele Peixoto  4 , Deborah S Yokoe  4 , Lindsey R Baden  4 , Francisco M Marty  4 , Sophia Koo  4
Affiliations

Risk factors for invasive fungal disease in heart transplant recipients

Alexander S Rabin et al. J Heart Lung Transplant. 2015 Feb.

Abstract

Background: Heart transplant (HT) recipients are at risk for invasive fungal disease (IFD), a morbid and potentially fatal complication.

Methods: We performed a retrospective cohort study to evaluate the incidence and risk factors for IFD in HT recipients from 1995 to 2012 at a single center. IFD cases were classified as proven or probable IFD according to current consensus definitions of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. We calculated IFD incidence rates and used Cox proportional hazards models to determine IFD risk factors.

Results: Three hundred sixty patients underwent HT during the study period. The most common indications were dilated (39%) and ischemic (37%) cardiomyopathy. There were 23 (6.4%) cases of proven (21) or probable (2) IFD, for a cumulative incidence rate of 1.23 per 100 person-years (95% CI 0.78 to 1.84). Candida (11) and Aspergillus (5) were the most common etiologic fungi. Thirteen cases (56%) occurred within 3 months of HT, with a 3-month incidence of 3.8% (95% CI 2.2 to 6.4). Delayed chest closure (HR 3.3, 95% CI 1.4 to 7.6, p = 0.01) and the addition of OKT3, anti-thymocyte globulin or daclizumab to standard corticosteroid induction therapy (HR 2.7, 95% CI 1.1 to 6.2, p = 0.02) were independently associated with an increased risk of IFD.

Conclusions: IFD incidence was greatest within the first 3 months post-HT, largely reflecting early surgical-site and nosocomial Candida and Aspergillus infections. Patients receiving additional induction immunosuppression or delayed chest closure were at increased risk for IFD. Peri-transplant anti-fungal prophylaxis should be considered in this subset of HT recipients.

Keywords: Aspergillus; Candida; heart transplantation; invasive fungal disease; risk factors.

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Conflict of interest statement

Disclosure statement

The authors have no conflicts of interest to disclose. S.K. is supported by a grant from the National Institutes of Health (K23 AI097225) and F.M.M. has received research support from Astellas and consulting honoraria from Astellas and Merck.

Figures

Figure 1
Figure 1
Freedom from invasive fungal disease by induction immunosuppression regimen.
Figure 2
Figure 2
Freedom from invasive fungal disease by delayed chest closure.
See this image and copyright information in PMC

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