Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation

BackgroundInfectious complications are a major cause of morbidity and mortality after heart transplantation (HT). However, the epidemiology and outcomes of these infections in the recent population of adult heart transplant recipients have not been investigated.MethodsWe conducted a single-center retrospective study on infectious complications occurring within 180days following HT on consecutive heart transplant recipients, from January 2011 to June 2015 at Bichat University Hospital in Paris, France. Risk factors for non-viral infections occurring within 8, 30 and 180days after HT were investigated using competing risk analysis.ResultsOverall, 113 patients were included. Fifty-eight (51%) HTs were high-priority allocations. Twenty-eight (25%) patients had an extracorporeal membrane oxygenation (ECMO) support at the time of transplantation. Ninety-two (81%) patients developed at least one infection within 180days after HT. Bacterial and fungal infections (n=181 episodes) occurred in 80 (71%) patients. The most common bacterial and fungal infections were pneumonia (n=95/181 episodes, 52%), followed by skin and soft tissue infections (n=26/181, 14%). Multi-drug-resistant bacteria were responsible for infections in 21 (19%) patients. Viral infections were diagnosed in 44 (34%) patients, mostly Cytomegalovirus infection (n=39, 34%). In multivariate subdistribution hazard model, prior cardiac surgery (subdistribution hazard ratio sHR=2.7 [95% CI 1.5-4.6] p<0.01) and epinephrine or norepinephrine at the time of HT (sHR=2.3 [95% CI 1.1-5.2] p=0.04) were significantly associated with non-viral infections within 8days after HT. Prior cardiac surgery (sHR=2.5 [95% CI 1.4-4.4] p<0.01), recipient age over 60years (sHR=2.0 [95% CI 1.2-3.3] p<0.01) and ECMO following HT (sHR=1.7 [95% CI 1.0-2.8] p=0.04) were significantly associated with non-viral infection within 30days after HT, as well as within 180days after HT.ConclusionThis study confirmed the high rate of infections following HT. Recipient age, prior cardiac surgery and ECMO following HT were independent risk factors for early and late bacterial and fungal infections.