Ventricular assist devices as bridge to heart transplantation: impact on post-transplant infections


Background:
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.

Methods:
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.

Results:
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.

Conclusion:
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.

Keywords:
Outcome, Cardiac transplantation, Mechanical heart support


Autoři: Delphine Héquet† 1,2;  Georg Kralidis† 3;  Thierry Carrel 4;  Alexia Cusini 5;  Christian Garzoni 5,6;  Roger Hullin 7;  Pascal R. Meylan 2,8;  Paul Mohacsi 9;  Nicolas J. Mueller 10;  Frank Ruschitzka 11;  Piergiorgio Tozzi 12;  Christian Van Delden 13;  Maja Weisser 14;  Markus J. Wilhelm 15;  Manuel Pascual 1;  Oriol Manuel 1,2,16*;  Swiss Transplant Cohort Study (stcs)
Působiště autorů: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. 1;  Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland. 10;  Department of Cardiology, Cardiovascular Center, University Hospital, University of Zurich, Zurich, Switzerland. 11;  Department of Cardiovascular Surgery, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. 12;  Transplant Infectious Diseases Unit, University Hospitals Geneva, Geneva, Switzerland. 13;  Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. 14;  Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. 15;  Infectious Diseases Service and Transplantation Center, University Hospital and University of Lausanne, BH 10/553, CHUV, Lausanne, Switzerland. 16;  Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. 2;  Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland. 3;  Clinic for Cardiovascular Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland. 4;  Department of Infectious Diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland. 5;  Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland. 6;  Department of Medicine, Service of Cardiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. 7;  Institute of Microbiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. 9Bern University Hospital and University of Bern, Bern, Switzerland. 8
Vyšlo v časopise: BMC Infectious diseases 2016, 16:321
Kategorie: Research article
prolekare.web.journal.doi_sk: 10.1186/s12879-016-1658-0

© 2016 The Author(s).
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1658-0

Souhrn

Background:
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.

Methods:
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.

Results:
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.

Conclusion:
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.

Keywords:
Outcome, Cardiac transplantation, Mechanical heart support


Zdroje

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