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Risk factors for early, cumulative, and fatal infections after heart transplantation: a multiinstitutional study
F W Smart1, D C Naftel, M R Costanzo
1Cardiac Transplant Research Database Group, University of Alabama at Birmingham, USA.
Background And Methods:
By multivariable analysis, risk factors were identified for initial infection of any type, cumulative infections during the first 6 months and fatal infection among 2210 heart transplant recipients at 30 institutions.
Results And Conclusions:
Of the 1218 infections in 695 patients, bacterial infections were most frequent (47%), followed by viral (42%), fungal (8%), and protozoal (4%). Risk factors for earlier infection included older recipient age (p < 0.0001), ventilator support at time of transplant (p < 0.0001), ventricular assist device at time of transplant (p = 0.02), OKT3 induction therapy (p < 0.0001), donor black race (p = 0.0007), and positive donor cytomegalovirus serology (for cytomegalovirus infection) (p = 0.0007). Cumulative infections during the first 6 months were increased by older recipient age (p < 0.0001), ventilator support at transplant (p = 0.0004), ventricular assist at transplant (p = 0.009), Black donor (p = 0.03), female donor (p = 0.03), and OKT3 induction therapy (p = 0.005). The actuarial freedom from fatal infection was 96% at 1 year and 95% at 3 years. Risk factors for death from infection included very old (p = 0.002) and very young recipients (p = 0.004), ventilator support at time of transplant (p = 0.004), older donor (p < 0.0001), and longer donor ischemic time (p = 0.02). The risk of death from infection within the first 3 months exceeded 20% among older recipients (> 55 years) on ventilator support at time of transplantation who received an older (> 50 years) donor heart.
Insights
Infections after heart transplant are common, with bacterial types most frequent. Older recipient age, ventilator use, and donor factors increase infection risk and mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- Infections pose a significant threat to heart transplant recipients.
- Understanding risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify risk factors for initial, cumulative, and fatal infections in heart transplant recipients.
- To analyze the types and frequencies of infections post-transplant.
Main Methods:
- Multivariable analysis was performed on data from 2210 heart transplant recipients across 30 institutions.
- Risk factors were assessed for initial, cumulative (first 6 months), and fatal infections.
Main Results:
- Bacterial infections were most common (47%), followed by viral (42%).
- Older recipient age, ventilator support, ventricular assist device use, OKT3 induction, and donor characteristics (Black race, CMV serology) were associated with increased infection risk.
- Older recipient age, ventilator support, female donor, and OKT3 induction increased cumulative infections.
- Very old/young recipients, ventilator support, older donor age, and longer donor ischemic time were risk factors for fatal infections.
Conclusions:
- Specific recipient and donor factors significantly influence infection risk and outcomes after heart transplantation.
- A high-risk subgroup of older recipients (>55 years) on ventilator support receiving older donor hearts (>50 years) faced over 20% risk of death from infection within 3 months.