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. 2019 Jan 25;9(1):17.
doi: 10.1186/s13613-019-0490-2.

Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation

Stéphanie Pons  1 , Romain Sonneville  2   3 , Lila Bouadma  1   4 , Lenka Styfalova  5 , Stéphane Ruckly  5 , Mathilde Neuville  1 , Aguila Radjou  1 , Jordane Lebut  1 , Marie-Pierre Dilly  6 , Bruno Mourvillier  1   4 , Richard Dorent  7 , Patrick Nataf  7 , Michel Wolff  1 , Jean-François Timsit  1   4
Affiliations

Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation

Stéphanie Pons et al. Ann Intensive Care. .

Abstract

Background: Infectious complications are a major cause of morbidity and mortality after heart transplantation (HT). However, the epidemiology and outcomes of these infections in the recent population of adult heart transplant recipients have not been investigated.

Methods: We conducted a single-center retrospective study on infectious complications occurring within 180 days following HT on consecutive heart transplant recipients, from January 2011 to June 2015 at Bichat University Hospital in Paris, France. Risk factors for non-viral infections occurring within 8, 30 and 180 days after HT were investigated using competing risk analysis.

Results: Overall, 113 patients were included. Fifty-eight (51%) HTs were high-priority allocations. Twenty-eight (25%) patients had an extracorporeal membrane oxygenation (ECMO) support at the time of transplantation. Ninety-two (81%) patients developed at least one infection within 180 days after HT. Bacterial and fungal infections (n = 181 episodes) occurred in 80 (71%) patients. The most common bacterial and fungal infections were pneumonia (n = 95/181 episodes, 52%), followed by skin and soft tissue infections (n = 26/181, 14%). Multi-drug-resistant bacteria were responsible for infections in 21 (19%) patients. Viral infections were diagnosed in 44 (34%) patients, mostly Cytomegalovirus infection (n = 39, 34%). In multivariate subdistribution hazard model, prior cardiac surgery (subdistribution hazard ratio sHR = 2.7 [95% CI 1.5-4.6] p < 0.01) and epinephrine or norepinephrine at the time of HT (sHR = 2.3 [95% CI 1.1-5.2] p = 0.04) were significantly associated with non-viral infections within 8 days after HT. Prior cardiac surgery (sHR = 2.5 [95% CI 1.4-4.4] p < 0.01), recipient age over 60 years (sHR = 2.0 [95% CI 1.2-3.3] p < 0.01) and ECMO following HT (sHR = 1.7 [95% CI 1.0-2.8] p = 0.04) were significantly associated with non-viral infection within 30 days after HT, as well as within 180 days after HT.

Conclusion: This study confirmed the high rate of infections following HT. Recipient age, prior cardiac surgery and ECMO following HT were independent risk factors for early and late bacterial and fungal infections.

Keywords: Extracorporeal membrane oxygenation; Heart transplantation; Infections; Outcome.

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Figures

Fig. 1
Fig. 1
Percentage of adult heart transplant recipients (n = 113) infected by different pathogens according to the postoperative period (before day 8, days 8 to 30 and days 31 to 180*). *A same patient can have been infected multiple times by the same pathogen and during different time periods
See this image and copyright information in PMC

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