Effect of infectious diseases on outcome after heart transplant

Diederik Van De Beek, Walter K Kremers, Jose L. Del Pozo, Richard C. Daly, Brooks Sayre Edwards, Christopher G A McGregor, Robin Patel

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

OBJECTIVE: To determine how often cardiac allograft recipients develop infectious diseases and how the infections affect these patients. PATIENTS AND METHODS: We retrospectively studied 313 patients who underwent heart transplant at Mayo Clinic's site in Rochester, MN, from January 1, 1988, through June 30, 2006. RESULTS: In the early postoperative period (ie, period between heart transplant and discharge from the hospital), infectious diseases occurred in 70 (22%) of 313 patients but were not associated with 1-year mortality; the most commonly infected sites were the lungs (7%), bloodstream (6%), upper respiratory tract (5%), and urinary tract (4%). In the 18 years after transplant, the cumulative incidence of infectious diseases was 93%; the most common infectious complications were skin and soft tissue (63%), urinary tract (46%), cytomegalovirus (40%), lung (36%), upper respiratory tract (23%), and varicella zoster virus (15%) infections. After adjustment for baseline predictors, lung (hazard ratio [HR], 3.87; 95% confidence interval [CI], 2.49-6.02; P<.001) and central nervous system (HR, 4.48; 95% CI, 1.75-11.46; P=.002) infections were predictive of mortality. Serum creatinine levels (HR, 1.74; 95% CI, 1.07-2.81; P=.02) and sirolimus use (HR, 2.72; 95% CI, 1.00-7.36; P=.05) were predictive of lung infection. Death occurred during the study period in 95 (30%) of 313 patients, with a cumulative incidence of 71% at 18 years. The cause of death was infection in 17 (18%) of 95 patients. CONCLUSION: Early postoperative infectious complications are frequent in cardiac allograft recipients but are not associated with 1-year mortality. Lung and central nervous system infections are predictors of mortality.

Original languageEnglish (US)
Pages (from-to)304-308
Number of pages5
JournalMayo Clinic Proceedings
Volume83
Issue number3
DOIs
StatePublished - 2008

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Communicable Diseases
Transplants
Lung
Confidence Intervals
Mortality
Infection
Urinary Tract
Respiratory System
Allografts
Central Nervous System Infections
Human Herpesvirus 3
Incidence
Virus Diseases
Sirolimus
Cytomegalovirus
Postoperative Period
Cause of Death
Creatinine
Central Nervous System
Skin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effect of infectious diseases on outcome after heart transplant. / Van De Beek, Diederik; Kremers, Walter K; Del Pozo, Jose L.; Daly, Richard C.; Edwards, Brooks Sayre; McGregor, Christopher G A; Patel, Robin.

In: Mayo Clinic Proceedings, Vol. 83, No. 3, 2008, p. 304-308.

Research output: Contribution to journalArticle

Van De Beek, Diederik ; Kremers, Walter K ; Del Pozo, Jose L. ; Daly, Richard C. ; Edwards, Brooks Sayre ; McGregor, Christopher G A ; Patel, Robin. / Effect of infectious diseases on outcome after heart transplant. In: Mayo Clinic Proceedings. 2008 ; Vol. 83, No. 3. pp. 304-308.
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AB - OBJECTIVE: To determine how often cardiac allograft recipients develop infectious diseases and how the infections affect these patients. PATIENTS AND METHODS: We retrospectively studied 313 patients who underwent heart transplant at Mayo Clinic's site in Rochester, MN, from January 1, 1988, through June 30, 2006. RESULTS: In the early postoperative period (ie, period between heart transplant and discharge from the hospital), infectious diseases occurred in 70 (22%) of 313 patients but were not associated with 1-year mortality; the most commonly infected sites were the lungs (7%), bloodstream (6%), upper respiratory tract (5%), and urinary tract (4%). In the 18 years after transplant, the cumulative incidence of infectious diseases was 93%; the most common infectious complications were skin and soft tissue (63%), urinary tract (46%), cytomegalovirus (40%), lung (36%), upper respiratory tract (23%), and varicella zoster virus (15%) infections. After adjustment for baseline predictors, lung (hazard ratio [HR], 3.87; 95% confidence interval [CI], 2.49-6.02; P<.001) and central nervous system (HR, 4.48; 95% CI, 1.75-11.46; P=.002) infections were predictive of mortality. Serum creatinine levels (HR, 1.74; 95% CI, 1.07-2.81; P=.02) and sirolimus use (HR, 2.72; 95% CI, 1.00-7.36; P=.05) were predictive of lung infection. Death occurred during the study period in 95 (30%) of 313 patients, with a cumulative incidence of 71% at 18 years. The cause of death was infection in 17 (18%) of 95 patients. CONCLUSION: Early postoperative infectious complications are frequent in cardiac allograft recipients but are not associated with 1-year mortality. Lung and central nervous system infections are predictors of mortality.

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