title: Risk factors for invasive fungal disease in heart transplant recipients.
abstract: BACKGROUND
  Heart transplant (HT) recipients are at risk for invasive fungal disease (IFD), a morbid and potentially fatal complication.
  
  
  METHODS
  We performed a retrospective cohort study to evaluate the incidence and risk factors for IFD in HT recipients from 1995 to 2012 at a single center. IFD cases were classified as proven or probable IFD according to current consensus definitions of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. We calculated IFD incidence rates and used Cox proportional hazards models to determine IFD risk factors.
  
  
  RESULTS
  Three hundred sixty patients underwent HT during the study period. The most common indications were dilated (39%) and ischemic (37%) cardiomyopathy. There were 23 (6.4%) cases of proven (21) or probable (2) IFD, for a cumulative incidence rate of 1.23 per 100 person-years (95% CI 0.78 to 1.84). Candida (11) and Aspergillus (5) were the most common etiologic fungi. Thirteen cases (56%) occurred within 3 months of HT, with a 3-month incidence of 3.8% (95% CI 2.2 to 6.4). Delayed chest closure (HR 3.3, 95% CI 1.4 to 7.6, p = 0.01) and the addition of OKT3, anti-thymocyte globulin or daclizumab to standard corticosteroid induction therapy (HR 2.7, 95% CI 1.1 to 6.2, p = 0.02) were independently associated with an increased risk of IFD.
  
  
  CONCLUSIONS
  IFD incidence was greatest within the first 3 months post-HT, largely reflecting early surgical-site and nosocomial Candida and Aspergillus infections. Patients receiving additional induction immunosuppression or delayed chest closure were at increased risk for IFD. Peri-transplant anti-fungal prophylaxis should be considered in this subset of HT recipients.
authors.affiliation: Division of Infectious Diseases. Electronic address: arabin@partners.org.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rabin
authors.affiliation: Cardiovascular Division.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.affiliation: Division of Infectious Diseases.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Shea
authors.affiliation: Division of Infectious Diseases.
authors.forename: Driele
authors.initials: D
authors.lastname: Peixoto
authors.affiliation: Division of Infectious Diseases.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Yokoe
authors.affiliation: Division of Infectious Diseases.
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Baden
authors.affiliation: Division of Infectious Diseases.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Marty
authors.affiliation: Division of Infectious Diseases.
authors.forename: Sophia
authors.initials: S
authors.lastname: Koo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D066027:Transplant Recipients; D055815:Young Adult
keywords: Aspergillus; Candida; heart transplantation; invasive fungal disease; risk factors