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Increased risk of pneumococcal infections in cardiac transplant recipients
I J Amber1, E M Gilbert, G Schiffman
1Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City.
Abstract:
We observed 5 episodes of pneumococcal infection among 129 cardiac transplant patients between March 1985 and December 1987, giving an estimated incidence of 36 cases per 1000 patient-years. Infections occurred a mean of 58 days after transplantation and included bacteremia with empyema, bacteremia alone, and pneumonia. All patients recovered from their infections. There was no correlation between infection and age, sex, immunosuppression, or rejection episodes. We also measured antibody levels to 12 pneumococcal antigens in 6 unvaccinated, uninfected patients before and after cardiac transplantation, to see if baseline antibody levels decreased. Protective levels of antibody were defined as greater than or equal to 300 ng of anticapsular antibody nitrogen per milliliter serum. Before transplantation patients had protective antibody levels to a mean of 8.7 +/- 1.2 pneumococcal serotypes; after transplantation, the number of presumably protective antibody levels decreased to 6.5 +/- 1.4 (P = 0.021). One of these patients subsequently developed pneumococcal pneumonia. Cardiac transplant patients are at increased risk of pneumococcal infections. Vaccinating transplant candidates prior to transplantation may provide protection after transplantation.
Insights
Cardiac transplant recipients face a higher risk of pneumococcal infections. Antibody levels to pneumococcal serotypes decrease after transplantation, suggesting vaccination before surgery may improve post-transplant immunity.
Area of Science:
- Immunology
- Infectious Diseases
- Transplantation Medicine
Background:
- Cardiac transplant recipients are susceptible to infections.
- Pneumococcal infections pose a significant risk in immunocompromised patients.
Purpose of the Study:
- To determine the incidence of pneumococcal infections in cardiac transplant patients.
- To assess changes in antibody levels to pneumococcal antigens post-transplantation.
Main Methods:
- Retrospective analysis of 5 pneumococcal infection episodes in 129 cardiac transplant patients (March 1985 - December 1987).
- Measurement of antibody levels to 12 pneumococcal antigens in 6 unvaccinated patients before and after transplantation.
Main Results:
- An estimated incidence of 36 pneumococcal infections per 1000 patient-years was observed.
- Infections occurred a mean of 58 days post-transplantation, including bacteremia and pneumonia; all patients recovered.
- Protective antibody levels to pneumococcal serotypes decreased significantly after transplantation (8.7 to 6.5 serotypes, P=0.021).
Conclusions:
- Cardiac transplant patients are at increased risk for pneumococcal infections.
- A decline in protective antibody levels post-transplantation was noted.
- Pre-transplantation vaccination may enhance protection against pneumococcal infections.