Infectious complications after cardiac transplantation in patients bridged with mechanical circulatory support devices versus medical therapy

• Published in: The Journal of heart and lung transplantation Vol. 35; no. 9; pp. 1116 - 1123
• Main Authors: Varr, Brandon C, Restaino, Susan W, Farr, Maryjane, Scully, Brian, Colombo, Paolo C, Naka, Yoshifumi, Mancini, Donna M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2016
• Subjects: Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; infection; left ventricular assist device; mechanical circulatory support; Postoperative Complications; Retrospective Studies; Surgery; Treatment Outcome; mechanical circulatory support; infection; left ventricular assist device; heart transplantation
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2016.04.016

Background Mechanical circulatory support (MCS) is increasingly used as a bridge to heart transplantation. It is not known whether patients who receive MCS as bridge to transplantation (BTT) suffer from more frequent and severe infectious complications in the first transplant year. Methods Using a retrospective cohort in a single large transplant center from 2009-2014, we compared rates of post-transplant infections among patients bridged to transplantation with medical therapy (n= 134) versus MCS (n= 178) over the first post-transplant year. Serious infections necessitated greater than 14 days of continuous intravenous antibiotic therapy. Results Pre-transplant device infections were common in the MCS group (32.6%). The proportion of patients with any infection (74.2% vs 60.5%, p=0.01, RR 1.23 [1.04-1.44]) or serious infections (45.5% vs 31.3%, p=0.01, RR 1.45 [1.08-1.96]) in the first post-transplant year was significantly higher in the MCS group versus the medical therapy group, respectively. MCS patients but not medical therapy patients had significantly higher one year all-cause mortality in the presence of postoperative infections (16.7% vs 4.3%, p=0.04). Device related infections occurred in 67 (37.6%) MCS patients up to 337 days post-transplant, including 26 (14.6%) patients without a known or active pre-operative device infection. In multivariable analysis, age, intensive care unit length of stay, presence of pre-transplant device infection, and use of an anti-thymocyte agent were associated with increased rates of infection. Conclusion More infectious complications are experienced by patients who receive MCS as BTT, with a significant occurrence of device related infections. MCS patients with post-transplant infections have increased mortality at one year compared to uninfected MCS patients.