Infections in Heart and Lung Transplant Recipients (original) (raw)
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Epidemiology and clinical impact of infection in patients awaiting heart transplantation
International Journal of Infectious Diseases, 2013
The aim of this study was to determine the epidemiology and clinical impact of infections in patients awaiting heart transplantation. Methods: We evaluated all patients considered for a heart transplant in our center over a period of 18 months over a period of 18 months from 2007 to 2009. The patients were followed up for 8 months or until death, transplant, or loss to follow-up. Results: Ninety patients were included in the study. During follow-up, 25 infections were recorded in 22 heart transplant candidates (24.4%). Respiratory infections were the most frequent infection (12 bronchitis; 48.0%), followed by skin and soft tissue infections (four infections; 16.0%), intra-abdominal infections (four infectious diarrhea; 16.0%), bacteremia (three infections; 12.0%), and urinary tract infections (two infections; 2.0%). Age, comorbidity, sex, and diabetes were not found to be risk factors for infection. Twenty-four patients (26.7%) were transplanted during follow-up. Infection before transplantation was not associated with an increased risk of mortality or a higher rate of infection in the immediate post-transplant period. Conclusions: Infections are common in heart transplant candidates, affecting almost 25% of them. Respiratory tract infections are the most frequent type of infection. However, they are not associated with increased mortality in the immediate post-transplant period.
Respirology, 2013
Lung transplantation has become an accepted therapeutic procedure for the treatment of end-stage pulmonary parenchymal and vascular disease. Despite improved survival rates over the decades, lung transplant recipients have lower survival rates than other solid organ transplant recipients. The morbidity and mortality following lung transplantation is largely due to infection-and rejection-related complications. This article will review the common infections that develop in the lung transplant recipient, including the general risk factors for infection in this population, and the most frequent bacterial, viral, fungal and other less frequent opportunistic infections. The epidemiology, diagnosis, prophylaxis, treatment and outcomes for the different microbial pathogens will be reviewed. The effects of infection on lung transplant rejection will also be discussed.
Infection in Organ Transplantation: Risk Factors and Evolving Patterns of Infection
Infectious Disease Clinics of North America, 2010
The evolution of immunosuppression for organ transplantation has reduced the incidence of acute graft rejection but has increased the risk for infection and virally mediated malignancie 1-6 The clinical diagnosis of infection is complicated by the relative absence of signs and symptoms of inflammation, alterations in anatomy caused by transplantation surgery, denervation of grafts, and underlying diseases such as diabetes or cirrhosis. Several noninfectious causes of fever (graft rejection, drug reactions, autoimmune disorders) may mimic infection. Established infection is poorly tolerated in transplant recipients with a high level of associated morbidity. Equally important, the toxicities and interactions of antimicrobial agents with the standard immunosuppressive agents used to prevent graft rejection are often amplified because of underlying organ dysfunction. As a result, early and specific microbiologic diagnoses and rapid treatment of infections are essential. Advanced radiologic techniques and invasive diagnostic procedures may be required to establish firm microbiologic diagnoses. The relatively recent availability of quantitative molecular and antibody-based diagnostic assays has facilitated such early diagnoses and these are now used routinely in transplant infectious disease management.
Journal of Heart and Lung Transplantation, 2006
Cardiac transplant recipients are often given prophylactic treatments to prevent opportunistic infections such as Pneumocystis carinii. Toxoplasmosis prophylaxis is commonly prescribed for transplant recipients who have not been exposed to this disease but receive a heart from an exposed donor. We reviewed the collective 28-year experience at two urban transplant programs with 596 patients, and found no cases of toxoplasmosis, but all patients received trimethoprim-sulfamethoxazole to prevent Pneumocystis pneumonia. We conclude that specific anti-toxoplasmosis prophylaxis is unnecessary in heart transplant recipients. J Heart Lung Transplant 2006;25:1380 -2.
Infections in the first year after heart transplantation in a Latin American country
Transplant Infectious Disease, 2023
Background Heart transplantation is the therapy of choice in patients with advanced heart failure refractory to other medical or surgical management. However, heart transplants are associated with complications that increase posttransplant morbidity and mortality. Infections are one of the most important complications after this procedure. Therefore, infections in the first year after heart transplantation were evaluated. Methods A retrospective cohort study of infections after heart transplants was conducted in a teaching hospital in Colombia between 2011 and 2019. Patients registered in the institutional heart transplant database (RETRAC) were included in the study. Microbiological isolates and infectious serological data were matched with the identities of heart transplant recipients and data from clinical records of individuals registered in the RETRAC were analyzed. The cumulative incidences of events according to the type of microorganism isolated were estimated using Kaplan–Meier survival analyses. Results Seventy-nine patients were included in the study. Median age was 49 years (37.4–56.3), and 26.58% of patients were women. Eighty-seven infections were documented, of which 55.17% (48) were bacterial, 22.99% (20) were viral, and 12.64% (11) were fungal. Bacterial infections predominated in the first month. In the first year, infections caused 38.96% of hospital admissions and were the second cause of death after heart transplants (25.0%). Conclusion Posttransplant infections in the first year of follow-up were frequent. Bacterial infections predominated in the early posttransplant period. Infections, mainly bacterial, were the second most common cause of death and the most common cause of hospitalization in the first year after heart transplantation.
Infectious complications in 100 consecutive heart transplant recipients
European Journal of Clinical Microbiology & Infectious Diseases, 1994
Clinical and laboratory data on infectious complications in 100 consecutive heart transplant recipients were analyzed retrospectively. The mean length of follow-up was 651±466 days. All patients received a basic immunosuppressive regimen including cyclosporine (whole blood target trough level 400–600 µg/l), azathioprine (1 mg/kg/day) and prednisone (0.15 mg/kg/day). Early rejection prophylaxis consisted of polyclonal rabbit antithymocyte globulin (ATG) (4 mg/kg/day for