Infectious complications after cardiac transplantation in patients bridged with mechanical circulatory support devices versus medical therapy

被引：13

作者：

Varr, Brandon C. ^{[1
]}

Restaino, Susan W. ^{[1
]}

Farr, Maryjane ^{[1
]}

Scully, Brian ^{[2
]}

Colombo, Paolo C. ^{[1
]}

Naka, Yoshifumi ^{[3
]}

Mancini, Donna M. ^{[1
]}

机构：

[1] Columbia Univ, Med Ctr, Dept Med, Div Cardiol, 622 West 168th St,PH 10-203, New York, NY 10032 USA

[2] Columbia Univ, Med Ctr, Div Infect Dis, New York, NY USA

[3] Columbia Univ, Med Ctr, Div Cardiothorac Surg, Dept Surg, New York, NY USA

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2016年 / 35卷 / 09期

关键词：

infection; heart transplantation; mechanical circulatory support; left ventricular assist device; VENTRICULAR ASSIST DEVICE; CONTINUOUS-FLOW; HEART-TRANSPLANT; ALLOCATION; MORTALITY; OUTCOMES; REGISTRY; IMPACT;

D O I：

10.1016/j.healun.2016.04.016

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Mechanical circulatory support (MCS) is increasingly used as a bridge to heart transplantation. It is not known whether patients who receive MCS as bridge to transplantation (BTT) have more frequent and severe infectious complications in the first transplant year. METHODS: Using a retrospective cohort in a single large transplant center from 2009 to 2014, we compared rates of post-transplant infections among patients bridged to transplantation with medical therapy (n = 134) or MCS (n = 178) over the first post-transplant year. Serious infections necessitated > 14 days of continuous intravenous antibiotic therapy. RESULTS: Pre-transplant device infections were common in the MCS group (32.6%). The proportion of patients with any infection (74.2% vs 60.5%; p = 0.01, relative risk 1.23 [1.04 to 1.44]) or serious infections (45.5% vs 31.3%; p = 0.01, relative risk 1.45 [1.08 to 1.96]) in the first post-transplant year was significantly higher in the MCS group than in the medical therapy group, respectively. MCS patients but not medical therapy patients had significantly higher 1-year all-cause mortality in the presence of post-operative infections (16.7% vs 4.3%, p = 0.04). Device-related infections occurred in 67 (37.6%) MCS patients up to 337 days post-transplant, including 26 (14.6%) patients without a known or active pre-operative device infection. In multivariable analyses, age, intensive care unit length of stay, presence of pre-transplant device infection and use of an anti-thymocyte agent were associated with increased rates of infection. CONCLUSION: More infectious complications are experienced by patients who receive MCS as BIT, with a significant occurrence of device-related infections. MCS patients with post-transplant infections have higher mortality at 1 year compared with uninfected MCS patients. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

引用

页码：1116 / 1123

页数：8

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