title: Ventricular assist devices as bridge to heart transplantation: impact on post-transplant infections.
abstract: Ventricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac transplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant infections in a nationwide cohort of heart transplant recipients.
  
  
  
  Heart transplant recipients included in the Swiss Transplant Cohort Study between May 2008 and December 2012 were analyzed. Cumulative incidence curves were used to calculate the incidence of bacterial or Candida infections (primary endpoint) and of other infections (secondary endpoint) after transplant. Cox regression models treating death as a competing risk were used to identify risk factors for the development of infection after transplant.
  
  
  
  Overall, 119 patients were included in the study, 35 with a VAD and 84 without VAD. Cumulative incidences of post-transplant bacterial or Candida infections were 37.7 % in VAD patients and 40.4 % in non-VAD patients. In multivariate analysis, the use of cotrimoxazole prophylaxis was the only variable associated with bacterial/Candida infections after transplant (HR 0.29 [95 % CI 0.15-0.57], p < 0.001), but presence of a VAD was not (HR 0.94, [95 % CI 0.38-2.32], p = 0.89, for continuous-flow devices, and HR 0.45 [0.15 - 1.34], p = 0.15, for other devices). Risk for post-transplant viral and all fungal infections was not increased in patients with VAD. One-year survival was 82.9 % (29/35) in the VAD group and 82.1 % (69/84) in the non-VAD group. All 6 patients in the VAD group that died after transplant had a history of pre-transplant VAD infection.
  
  
  
  In this nationwide cohort of heart transplant recipients, the presence of VAD at the time of transplant had no influence on the development of post-transplant infections.
authors.affiliation: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.|Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Delphine
authors.initials: D
authors.lastname: Héquet
authors.affiliation: Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Kralidis
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Department of Infectious Diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Alexia
authors.initials: A
authors.lastname: Cusini
authors.affiliation: Department of Infectious Diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.|Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Garzoni
authors.affiliation: Department of Medicine, Service of Cardiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Hullin
authors.affiliation: Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.|Institute of Microbiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Pascal R
authors.initials: PR
authors.lastname: Meylan
authors.affiliation: Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Mueller
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: Department of Cardiovascular Surgery, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.affiliation: Transplant Infectious Diseases Unit, University Hospitals Geneva, Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: van Delden
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Maja
authors.initials: M
authors.lastname: Weisser
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Wilhelm
authors.affiliation: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
authors.affiliation: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. oriol.manuel@chuv.ch.|Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. oriol.manuel@chuv.ch.|Infectious Diseases Service and Transplantation Center, University Hospital and University of Lausanne, BH 10/553, CHUV, Lausanne, Switzerland. oriol.manuel@chuv.ch.
authors.forename: Oriol
authors.initials: O
authors.lastname: Manuel
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014777:Virus Diseases / Q000453:epidemiology*
keywords: Cardiac transplantation; Mechanical heart support; Outcome