title: Do Prior Driveline Infections Increase the Risk of Infection in Heart Transplant Patients Treated With Rabbit Antithymocyte Globulin Induction Therapy?
abstract: BACKGROUND
  The use of mechanical circulatory support devices (MCSDs) has been increasing over the past several years. Driveline infections (DLIs) are one of the most common complications seen in these patients; reportedly, up to 50% of patients with MCSDs can develop this complication. It is believed that the removal of the driveline results in treatment of the localized infection area. MCSD patients are also known to develop circulating antibodies. These circulating antibodies have been associated with poor outcomes after heart transplantation. The use of rabbit antithymocyte globulin (ATG) as induction therapy reportedly decreases the development of circulating antibodies; it is now commonly used in sensitized patients undergoing heart transplantation. It is unknown whether ATG induction therapy immediate posttransplant will increase the risk of infection of those MCSD patients with DLIs.
  
  
  METHODS
  Between 2003 and 2013, we evaluated 57 MCSD patients who subsequently underwent heart transplantation and received ATG induction therapy. Patients were divided into those with previous MCSD DLI and those without, and they were assessed for 1-year freedom from infection (specifically, sternal wound infections). One-year survival and freedom from treated rejection, both cellular and antibody mediated, were also assessed.
  
  
  RESULTS
  MCSD patients with DLIs who received ATG induction did not have a lower freedom from any treated infection and from sternal wound infection posttransplant compared with those MCSD patients without DLIs and not treated with ATG induction. There were also no significant differences between the 2 groups in terms of 1-year posttransplant survival and freedom from treated rejection.
  
  
  CONCLUSIONS
  The use of ATG induction in patients with prior DLIs did not seem to increase the risk for posttransplant infection (eg, sternal wound infection). ATG induction can therefore be safely used in this population.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: D
authors.initials: D
authors.lastname: Arman
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: D
authors.initials: D
authors.lastname: Kuraitis
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Moriguchi
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: Hamilton
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: F
authors.initials: F
authors.lastname: Liou
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: S
authors.initials: S
authors.lastname: Siddiqui
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: Luu
authors.affiliation: Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: P
authors.initials: P
authors.lastname: Zakowski
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: F
authors.initials: F
authors.lastname: Arabia
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: kobashigawaj@cshs.org.
authors.forename: J
authors.initials: J
authors.lastname: Kobashigawa
mesh_terms: D000328:Adult; D000818:Animals; D000906:Antibodies / Q000097:blood; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000150:complications*; D011817:Rabbits; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology*
chemical_list: D000906:Antibodies; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents