Infections during left ventricular assist device support do not affect posttransplant outcomes.
BACKGROUND
Although infections acquired during ventricular assist device support may increase the risk of infection and have an impact on transplant survival, their true posttransplant consequences remain to be determined. This study evaluates the impact of an outpatient program, newer devices, and an updated infection management protocol on infection-related patient outcomes after transplant.


RESULTS
Eighty-six patients received a left ventricular assist device (LVAD) between June 1996 and June 1999. Fifty patients transplanted during the same period, without prior device support, were used as controls; they were matched to transplanted LVAD recipients by age, sex, diagnosis, and transplant date. The nature of and actuarial freedom from peritransplant and posttransplant infections were compared at 6 months after transplant; actuarial patient survival was compared at 3 years. Infection was defined as leukocytosis or leukopenia, with a positive culture requiring either medical or surgical intervention. Forty-four patients (51%) were successfully discharged home on LVAD support, and 61 (71%) were transplanted. A high incidence of infection during device support did not have an impact on pretransplant or posttransplant mortality, posttransplant infectious rate, or overall patient survival. Active infections at transplant also did not significantly influence 6-month mortality. In comparison, LVAD recipients had a lower freedom from infection than did controls (P:<0.05); however, 3-year survival did not differ: 79% and 87% for the LVAD and control groups, respectively.


CONCLUSIONS
Although LVADs increase the risk of infection in the early posttransplant period, this appears not to have an impact on transplantability or patient survival and likely reflects effective infection control in both inpatient and outpatient settings.
Sinha
P
P
Columbia University College of Physicians and Surgeons, Columbia Presbyterian Medical Center, New York, NY 10032, USA.
Chen
J M
JM
Flannery
M
M
Scully
B E
BE
Oz
M C
MC
Edwards
N M
NM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006331:Heart Diseases / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D010045:Outpatients; D011183:Postoperative Complications / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left