Invasive Fungal Infections in Orthotopic Heart Transplant Patients: Incidence and Risk Factors in the Modern Era

Invasive fungal infections (IFI) post-orthotopic heart transplant (OHT) have not been well studied due to limited information in large databases. The goal of the study is to describe the incidence and risk factors for IFI.

In this retrospective cohort study, we analyzed risk factors associated with IFI among OHT recipients in our center in the period 2010-2020. Patients were divided into two groups for comparison: IFI within the first year after transplant, and no IFI. We compared the groups to determine independent risk factors for IFI.

Out of 548 included patients, 29 patients experienced 29 IFI (incidence = 5.3%; 95% CI 3.7-7.5). Median (interquartile range) time to IFI was 44 days (10-238.5). Candida was the most identified pathogen (51%), followed by Aspergillus (27%) and Cryptococcus (9%). In multivariable logistic regression analyses, pretransplant fungal colonization/infection (odds ratio, [OR] 27, 95% CI 1.2-315), post-transplant reoperation (OR 5.8, 95% CI 2.2-15), and extracorporeal membrane oxygenation (ECMO) (OR 3.1, 95% CI 1.1-9.0) were associated with increased odds of IFI. Compared to patients without IFI, 1-year survival of patients with IFI was significantly worse (76 vs. 97%, p < 0.01).

We conclude there are specific, identifiable risk factors during the pre- and post-transplant periods associated with increased odds of IFI. These merit study of targeted antifungal prophylaxis with agents offering broad yeast and mold activity in OHT patients with certain risk factors.