Infective endocarditis following heart transplantation: A systematic review.

Area of Science:

• Cardiology
• Infectious Diseases
• Transplantation Medicine

Background:

• Infective endocarditis (IE) is a rare but life-threatening complication following heart transplantation (HTx).
• Limited literature exists on the specific patterns, clinical course, and outcomes of IE post-HTx.
• This study aims to consolidate existing data on IE following HTx.

Purpose of the Study:

• To define the characteristics of infective endocarditis (IE) in heart transplant (HTx) recipients.
• To explore management strategies for post-HTx IE.
• To analyze the outcomes and survival rates associated with IE following HTx.

Main Methods:

• A systematic electronic literature search was conducted across major databases (Cochrane, CINAHL, Medline, Scopus).
• Included were English-language articles reporting IE in adult patients post-HTx.
• Patient-level data were extracted and analyzed.

Main Results:

• The study identified 57 patients with IE post-HTx, with a median age of 52 years; 75% were male.
• Mitral valve IE was most common (36.8%), followed by mural (24.6%) and tricuspid valve (21.1%).
• Staphylococcus aureus (26.3%) and Aspergillus fumigatus (19.3%) were the most frequent pathogens. Overall case fatality was 44.6%, with fungal IE showing significantly higher mortality (75.0%) than bacterial IE (36.1%).

Conclusions:

• Fungal pathogens, including Aspergillus fumigatus, are significant causes of IE in heart transplant recipients.
• Survival rates for heart transplant patients with IE are generally poor.
• Outcomes may be particularly worse for IE caused by Aspergillus fumigatus.