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Infectious complications in infant heart transplantation

J Bork1, R Chinnock, K Ogata

  • 1Department of Pediatrics, Loma Linda University Medical Center, CA 92354.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|November 1, 1993
PubMed
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Serious infections remain a significant risk for infants post-heart transplant, with cytomegalovirus (CMV) being a key concern. Proactive management strategies are crucial for preventing severe outcomes in this vulnerable population.

Area of Science:

  • Pediatric Cardiology
  • Transplant Infectious Diseases
  • Immunology

Background:

  • While mild infections are comparable to the general population, serious infections pose a major threat in the initial months after infant heart transplantation.
  • Infectious causes accounted for 17% of deaths in infants undergoing transplantation at Loma Linda University Medical Center.
  • Cytomegalovirus (CMV) infections were observed in a significant portion of infants, primarily within the first 2-3 months post-transplant.

Purpose of the Study:

  • To analyze the incidence and characteristics of serious infections in infants (<1 year) following heart transplantation.
  • To identify specific pathogens and risk factors associated with severe post-transplant infections, particularly cytomegalovirus (CMV).
  • To evaluate the effectiveness of current prophylactic and therapeutic protocols in managing these infections.

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Main Methods:

  • Retrospective analysis of 128 infants (<1 year) who underwent heart transplantation between 1989 and 1992.
  • Detailed review of infection episodes, including type, timing, and causative agents.
  • Assessment of current protocols involving intravenous immunoglobulin, oral acyclovir, and ganciclovir for infection prevention and treatment.

Main Results:

  • 65 out of 128 infants experienced at least one serious infection, including bacterial meningitis and viral pneumonia.
  • 19 infants developed cytomegalovirus (CMV) infections, predominantly in the early post-transplant period (first 2-3 months).
  • Eight infants had successfully treated Pneumocystis pneumonia; no deaths were directly attributed to CMV.

Conclusions:

  • Serious infections, especially cytomegalovirus (CMV), represent a significant morbidity and mortality risk in the early period after infant heart transplantation.
  • The highest risk for CMV infection is in seronegative recipients of organs from seropositive donors, typically within 4-8 weeks post-transplant.
  • Current protocols combining immunoglobulin, acyclovir, and ganciclovir aim to mitigate infection risk, highlighting the need for vigilant monitoring and management.