title: Safety and Feasibility of Induction Immunosuppression When Driveline Infection Is an Indication for Cardiac Transplantation.
abstract: BACKGROUND
  There is a paucity of data on the use of induction immunosuppression in patients with active infections undergoing orthotopic heart transplantation (OHT). We hypothesized that induction immunosuppression in patients with ventricular assist device (VAD) undergoing OHT with localized active driveline infection (DLI) does not lead to worse outcomes.
  
  
  METHODS
  We retrospectively analyzed our database for bridge-to-transplant VAD patients who underwent OHT and received induction therapy. Patients were stratified into those with and without active DLI at the time of OHT and followed up till death or at least 30 months after OHT. Posttransplant length of stay (LOS), frequency of infections, and mortality were compared between the two groups.
  
  
  RESULTS
  Thirty-eight patients (30 males) with mean age of 57.5 ± 13 years with VAD underwent OHT during the study period. Twelve had active DLI. Mean follow-up was 46.4 ± 23.1 months. In the DLI versus non-DLI group, there was no difference in mortality (17 vs. 23%, p = NS), LOS (16.3 ± 5.4 vs. 17.2 ± 13.7, p = NS), postoperative renal function, incidence of hyperacute or late rejection or infection either in the first month (25 vs. 23%, p = NS) or during entire follow-up (92 vs. 88%, p = NS). No patient in the DLI group had infections attributable to the same organism responsible for pretransplant DLI.
  
  
  CONCLUSIONS
  In patients with active DLI, induction immunosuppression after OHT did not increase LOS, infections, or mortality after at least 30 months of follow-up and therefore it appears to be a safe and feasible therapeutic option.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
authors.forename: Nirmanmoh
authors.initials: N
authors.lastname: Bhatia
authors.affiliation: Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, United States.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Voelkel
authors.affiliation: Department of Internal Medicine, University of Louisville, Louisville, Kentucky, United States.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Hussain
authors.affiliation: Division of Cardiovascular Medicine, University of Buffalo, Buffalo, New York, United States.
authors.forename: Umesh C
authors.initials: UC
authors.lastname: Sharma
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, United States.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Birks
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: McCants
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D007166:Immunosuppressive Agents