Effect of infectious diseases on outcome after heart transplant.
OBJECTIVE
To determine how often cardiac allograft recipients develop infectious diseases and how the infections affect these patients.


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 less than .001) and central nervous system (HR, 4.48; 95% CI, 1.75-11.46; P equals .002) infections were predictive of mortality. Serum creatinine levels (HR, 1.74; 95% CI, 1.07-2.81; P equals .02) and sirolimus use (HR, 2.72; 95% CI, 1.00-7.36; P equals .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.


CONCLUSIONS
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.
van de Beek
Diederik
D
Division of Clinical Microbiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Kremers
Walter K
WK
Del Pozo
Jose L
JL
Daly
Richard C
RC
Edwards
Brooks S
BS
McGregor
Christopher G A
CG
Patel
Robin
R
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate; D013997:Time Factors