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Nontuberculous mycobacterial infections in heart transplant recipients: a seventeen-year experience
R J Novick1, C E Moreno-Cabral, E B Stinson
1Department of Cardiovascular Surgery, Stanford University Medical Center, Calif.
Abstract:
A retrospective review was undertaken to determine the clinical features, outcome, and impact on survival of nontuberculous mycobacterial infections in 14 (of 502) heart transplant recipients. The prevalence of these infections was significantly higher (p less than 0.05) during the precyclosporine than during the cyclosporine era. The mean interval from transplantation to diagnosis was 3.5 +/- 0.7 years (+/- SEM). The 14 patients had a higher (p less than 0.05) linearized rejection rate than did other transplant patients during postoperative years 1, 2, and 4 to 6, and had received 7.3 +/- 2 gm of methylprednisolone as bolus treatment of rejection before diagnosis. Eight patients were initially seen with disseminated disease, four had localized pulmonary infection, one had subcutaneous infection in the previous site of a left ventricular assist device, and in one the organism was cultured from a fluid collection adjacent to a hip prosthesis. Twelve patients were first given 3 +/- 1 antimycobacterial drugs; the infections were usually controlled, but in 75% of patients the therapeutic regimen was prematurely stopped or altered because of drug toxicity. Mycobacterial infection was a contributory cause of death in only one patient. Actuarial survival in the 14 patients was not significantly different from the entire transplant population at 4 to 7 years. We conclude that nontuberculous mycobacterial infections occur late after heart transplantation, that drug treatment is usually successful (although difficult), and that long-term survival is not adversely affected if the infection is successfully controlled.
Insights
Nontuberculous mycobacterial infections occur late after heart transplantation. Successful treatment is possible, and long-term survival is not affected if infections are controlled.
Area of Science:
- Infectious Diseases
- Cardiology
- Transplantation Medicine
Background:
- Nontuberculous mycobacterial (NTM) infections are a potential complication following heart transplantation.
- Understanding the clinical features and outcomes of NTM infections is crucial for patient management.
Purpose of the Study:
- To determine the clinical features, outcomes, and survival impact of NTM infections in heart transplant recipients.
- To compare the prevalence of NTM infections in precyclosporine versus cyclosporine eras.
Main Methods:
- Retrospective review of 14 heart transplant recipients with NTM infections (out of 502 total recipients).
- Analysis of clinical features, treatment regimens, drug toxicity, and survival data.
- Comparison of rejection rates between patients with and without NTM infections.
Main Results:
- NTM infections occurred a mean of 3.5 years post-transplant.
- Patients with NTM infections had higher rejection rates.
- Antimycobacterial drug treatment was often successful but frequently complicated by toxicity.
- Mycobacterial infection contributed to death in only one patient.
- Actuarial survival was not significantly different from the general transplant population.
Conclusions:
- NTM infections occur late after heart transplantation.
- Successful control of NTM infections, despite treatment challenges, does not adversely affect long-term survival.
- Cyclosporine era showed a lower prevalence of these infections compared to the precyclosporine era.