Infectious complications after cardiac transplantation in patients bridged with mechanical circulatory support devices versus medical therapy.
Mechanical circulatory support (MCS) is increasingly used as a bridge to heart transplantation. It is not known whether patients who receive MCS as bridge to transplantation (BTT) have more frequent and severe infectious complications in the first transplant year.



Using a retrospective cohort in a single large transplant center from 2009 to 2014, we compared rates of post-transplant infections among patients bridged to transplantation with medical therapy (n = 134) or MCS (n = 178) over the first post-transplant year. Serious infections necessitated >14 days of continuous intravenous antibiotic therapy.



Pre-transplant device infections were common in the MCS group (32.6%). The proportion of patients with any infection (74.2% vs 60.5%; p = 0.01, relative risk 1.23 [1.04 to 1.44]) or serious infections (45.5% vs 31.3%; p = 0.01, relative risk 1.45 [1.08 to 1.96]) in the first post-transplant year was significantly higher in the MCS group than in the medical therapy group, respectively. MCS patients but not medical therapy patients had significantly higher 1-year all-cause mortality in the presence of post-operative infections (16.7% vs 4.3%, p = 0.04). Device-related infections occurred in 67 (37.6%) MCS patients up to 337 days post-transplant, including 26 (14.6%) patients without a known or active pre-operative device infection. In multivariable analyses, age, intensive care unit length of stay, presence of pre-transplant device infection and use of an anti-thymocyte agent were associated with increased rates of infection.



More infectious complications are experienced by patients who receive MCS as BTT, with a significant occurrence of device-related infections. MCS patients with post-transplant infections have higher mortality at 1 year compared with uninfected MCS patients.
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA. Electronic address: bcv2103@cumc.columbia.edu.
Brandon C
BC
Varr
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
Susan W
SW
Restaino
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
Maryjane
M
Farr
Division of Infectious Disease, Columbia University Medical Center, New York, New York, USA.
Brian
B
Scully
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
Paolo C
PC
Colombo
Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York, USA.
Yoshifumi
Y
Naka
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
Donna M
DM
Mancini
D006333:Heart Failure; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
heart transplantation; infection; left ventricular assist device; mechanical circulatory support