Effect of Infectious Diseases on Outcome After Heart Transplant

• Published in: Mayo Clinic proceedings Vol. 83; no. 3; pp. 304 - 308
• Main Authors: van de Beek, Diederik, MD, PhD, Kremers, Walter K., PhD, Del Pozo, Jose L., MD, Daly, Richard C., MD, Edwards, Brooks S., MD, McGregor, Christopher G.A., MB, FRCS, Patel, Robin, MD
• Format: Journal Article
• Language: English
• Published: Rochester, MN Mayo Medical Ventures 01-03-2008; Elsevier, Inc; Elsevier Limited
• Subjects: Adolescent; Adult; Biological and medical sciences; Care and treatment; Child; Child, Preschool; Communicable diseases; Confidence Intervals; Diagnosis; Female; Follow-Up Studies; General aspects; Heart; Heart Failure - surgery; Heart Transplantation; Humans; Incidence; Infection - epidemiology; Infection - etiology; Internal Medicine; Male; Medical sciences; Middle Aged; Minnesota - epidemiology; Patient outcomes; Prognosis; Retrospective Studies; Risk Factors; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Survival Rate; Time Factors; Transplantation; Minnesota; United States; CI; CNS; HR; HSV; IQR; interquartile range; CMV; central nervous system; herpes simplex virus; VZV; cytomegalovirus; hazard ratio; varicella zoster virus; confidence interval; Heart; Infection; Medicine; Prognosis; Treatment; Surgery; Graft; Evolution; Transplantation; Homotransplantation
• ISSN: 0025-6196; 1942-5546
• DOI: 10.4065/83.3.304

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 <.001) and central nervous system (HR, 4.48; 95% CI, 1.75-11.46; P =.002) infections were predictive of mortality. Serum creatinine levels (HR, 1.74; 95% CI, 1.07-2.81; P =.02) and sirolimus use (HR, 2.72; 95% CI, 1.00-7.36; P =.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.