Risk factors for early, cumulative, and fatal infections after heart transplantation: a multiinstitutional study.
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.


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.
Smart
F W
FW
Cardiac Transplant Research Database Group, University of Alabama at Birmingham, USA.
Naftel
D C
DC
Costanzo
M R
MR
Levine
T B
TB
Pelletier
G B
GB
Yancy
C W
CW
Hobbs
R E
RE
Kirklin
J K
JK
Bourge
R C
RC
D000206:Actuarial Analysis; D001741:Black or African American; D000367:Age Factors; D001424:Bacterial Infections / Q000453:epidemiology*; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use; D009181:Mycoses / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011528:Protozoan Infections / Q000453:epidemiology*; D012121:Respiration, Artificial; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014019:Tissue Donors; D014777:Virus Diseases / Q000453:epidemiology*
D007166:Immunosuppressive Agents; D016853:Muromonab-CD3