Recent Trends of Infectious Complications Following Heart Transplantation
| Autor: | Alfredo G. Puing, Helen Luikart, Ashrit Multani, Kiran K. Khush, Donn W. Garvert, Heather J. Ross, Yasbanoo Moayedi, Carlos A. Gomez, Jose G. Montoya, Paul E. Bunce, E.J. Henricksen, Maxime Tremblay-Gravel, Jeffrey J. Teuteberg |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Antifungal Agents Time Factors medicine.medical_treatment Congenital cytomegalovirus infection Opportunistic Infections Antiviral Agents Risk Assessment California Serology Mycobacterium tuberculosis Immunocompromised Host Risk Factors Internal medicine medicine Humans Pneumocystis jirovecii Retrospective Studies Heart transplantation Transplantation biology business.industry Immunosuppression Nocardia Bacterial Infections Antibiotic Prophylaxis Middle Aged Protective Factors biology.organism_classification medicine.disease Anti-Bacterial Agents Treatment Outcome Mycoses Virus Diseases Heart Transplantation Female Nocardia Infections business Immunosuppressive Agents |
| Zdroj: | Transplantation. 104:e284-e294 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000003307 |
| Popis: | Background Heart transplantation is a life-saving procedure that has seen improvements in transplant and patient outcomes due to advances in immunosuppression and prevention of posttransplantation infectious episodes (IEps). This study systematically evaluates IEps in the modern era of heart transplantation at Stanford University Medical Center. Methods This is a single-center retrospective review that includes 279 consecutive adult heart transplantation recipients from January 2008 to September 2017. Baseline demographic, clinical, serological, and outcomes information were collected. Kaplan-Meier estimator was used to assess survival stratified by IEp occurrence within the first year. Results A total of 600 IEps occurred in 279 patients (2.15 IEps per patient) during a median follow-up period of 3 years. Overall survival was 83.3% (95% confidence interval [CI], 76.2-88.4) at 1 year posttransplantation for those with any IEp compared with 93.0% (95% CI, 87.2-96.4) in those without IEp (P = 0.07). Bacterial IEps were the most common (n = 375; 62.5%), followed by viral (n = 180; 30.0%), fungal (n = 40; 6.7%), and parasitic (n = 5; 0.8%). IEps by Gram-negative bacteria (n = 210) outnumbered those by Gram-positive bacteria (n = 142). Compared with prior studies from our center, there was a decreased proportion of viral (including cytomegalovirus), fungal (including Aspergillus spp. and non-Aspergillus spp. molds), and Nocardia infections. There were no IEps due to Mycobacterium tuberculosis, Pneumocystis jirovecii, or Toxoplasma gondii. Conclusions A significant reduction in viral, fungal, and Nocardia IEps after heart transplantation was observed, most likely due to advancements in immunosuppression and preventive strategies, including pretransplant infectious diseases screening and antimicrobial prophylaxis. |
| Databáze: | OpenAIRE |
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