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Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Recent Trends in Hospitalizations for Infection in the First Year After Heart Transplantation
Shi Nan Feng1, Alexandra Rizaldi1, Atharv Oak1
1Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Hospitalization for infection after heart transplantation (HT) significantly increased during the COVID-19 pandemic. While infection risk rose, the risk of death post-HT remained stable, highlighting the need for infection prevention strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Medicine
Background:
- Infection is a primary cause of morbidity and mortality following heart transplantation (HT).
- Recent trends in post-HT infections warrant investigation, especially considering the impact of the COVID-19 pandemic.
Purpose of the Study:
- To investigate trends in first-year post-heart transplantation hospitalizations for infection.
- To assess the impact of the COVID-19 pandemic on infection rates and mortality after heart transplantation.
Main Methods:
- Utilized Organ Procurement and Transplantation Network data for adult HT recipients in the U.S. (October 2018-June 2023).
- Categorized transplants into three eras: pre-pandemic, early pandemic, and later pandemic.
- Compared first-year post-HT infection hospitalizations and survival rates using multivariable logistic regression and Cox proportional hazards regression.
Main Results:
- Hospitalization for infection within the first year post-HT increased significantly across eras: 2.9% (pre-pandemic), 5.4% (early pandemic), and 11.6% (later pandemic).
- Patients transplanted during the pandemic eras had significantly higher odds of infection hospitalization (OR 1.91 and 4.37) compared to the pre-pandemic era.
- No significant difference in the risk of death was observed for recipients transplanted during the pandemic eras compared to the pre-pandemic era.
Conclusions:
- The odds of first-year infection hospitalization after heart transplantation substantially increased during the COVID-19 pandemic.
- Despite increased infection risk, overall mortality risk post-heart transplantation did not significantly change during the pandemic.
Background:
Infection is a major cause of morbidity and mortality after heart transplantation (HT). Recent trends in post-HT infection demand further investigation, particularly given effects of the coronavirus disease 2019 (COVID-19) pandemic.
Methods:
We identified all adult HT recipients in the United States from October 18, 2018, to June 30, 2023, using Organ Procurement and Transplantation Network data. We categorized transplants into 3 eras, accounting for COVID-19: October 2018 to March 2020, March 2020 to March 2022, and after March 2022. Survival was compared using Kaplan-Meier survival analysis and Cox proportional hazards regression. Readmission hospitalizations for infection in the first year after HT were compared using multivariable logistic regression, adjusted for era and donor and recipient characteristics.
Results:
Of 13,663 patients who received HT (median age, 57 years; 72.9% men), hospitalization for infection in the first year after transplant was 2.9% (n = 3645) for patients who received a transplant in October 2018 to March 2020, 5.4% (n = 5658) for patients who received a transplant in March 2020 to March 2022 and 11.6% (n = 4360) for patients who received a transplant after March 2022 (P < .001). Compared with patients who received a transplant between October 2018 and March 2020, patients who received a transplant during March 2020 to March 2022 (adjusted odds ratio, 1.91; 95% CI, 1.51-2.41) and after March 2022 (adjusted odds ratio, 4.37; 95% CI, 3.30-5.78) eras were more likely to be hospitalized for infection in their first year after HT. After adjusting for covariates, we found no significant difference in the risk of death for recipients who received a transplant from March 2020 to March 2022 (adjusted hazard ratio, 0.86; 95% CI, 0.67-1.11; P = .257) or after March 2022 (adjusted hazard ratio, 1.01; 95% CI, 0.73-1.39, P = .955) compared with March 2018 to March 2020.
Conclusions:
Odds of hospitalization for infection in the first year after HT performed between March 2020 and March 2022 and after March 2022 were 1.91 and 4.37 times as high, respectively, as HT performed between October 2018 and March 2020.
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