Infections after cardiac transplantation: relation to rejection therapy

We have analyzed the relation of the treatment of 76 acute graft rejection episodes in 45 late postoperative cardiac transplant patients to the 56 infections occurring in these patients. Intensification of immunosuppressive therapy for acute rejection greatly increased the occurrence of infection from a control incidence of 1.3 infections per 1000 patient-days to a posttreatment incidence of 3.6. Two modes of treatment, increased oral prednisone and high-dose methylprednisolone plus antithymocyte globulin, were further analyzed. Actuarial analysis of infections after these two treatment modes showed that the treatment-related increase in infection was nearly exclusively due to the latter form of therapy. Invasive cardiac procedures did not appear to be causally related to infections in these immunocompromised patients.