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Late infection in cardiac allograft recipients: profiles, incidence, and outcome
J D Hosenpud1, R E Hershberger, G A Pantely
1Oregon Cardiac Transplant Program, Oregon Health Sciences University, Portland 97201.
Insights
Late infections after heart transplantation remain a concern, though less frequent than early post-transplant infections. These infections can lead to hospitalization and, rarely, death, highlighting the need for ongoing monitoring in heart transplant recipients.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Medicine
Background:
- Infection is a significant cause of morbidity and mortality following heart transplantation.
- Most research focuses on early post-transplant infections, leaving the long-term impact less understood.
Purpose of the Study:
- To investigate the incidence and characteristics of infections occurring more than 1 year after heart transplantation.
- To assess the long-term risk of late infections and related hospitalizations in heart transplant recipients.
Main Methods:
- A retrospective survey of 54 patients surviving at least 1 year post-heart transplantation.
- Analysis of infection data, hospitalizations, and outcomes beyond the first year.
Main Results:
- Fifteen infections were recorded in the study group, with an incidence of 0.3 infections per patient.
- Two late infections were fatal, and 6% of patients experienced late infections requiring hospitalization within 2 years.
- Bacterial infections were most common (60%), followed by viral (27%), with rare fungal pulmonary infections noted.
Conclusions:
- Infections continue to occur later after heart transplantation, albeit at lower rates than in the early post-transplant period.
- The risk of serious late infections, including those necessitating hospitalization, persists.
- Uncommon infectious agents associated with immunosuppression remain a threat in long-term heart transplant survivors.
Abstract:
Infection continues to cause substantial morbidity and mortality after heart transplantation. Studies focusing on this problem have concentrated on the early posttransplant period, and it is uncertain to what extent infection continues to add to morbidity later after transplantation. Fifty-four patients surviving at least 1 year after heart transplantation made up the study population in this study, and they were surveyed for infections beyond 1 year. In this group there were 15 infections, an incidence of 0.3 infections per patient or 0.016 infections per patient-months of follow-up. Only nine of these infections necessitated hospitalization; two, however, were fatal. Actuarial risk of all late infections and late infections necessitating hospitalization was 13% and 6%, respectively, at 2 years. As expected, bacterial infections made up the largest group (60%), followed by viral disease (27%). Two patients had pulmonary infections, one with Aspergillus and one with Pneumocystis. These data demonstrate that although rates of infection in heart recipients continue to exceed those in the general population, the rates are considerably lower than those in what is seen early after heart transplantation. Despite this, the more unusual infectious agents associated with immune compromise continue to be present.