Infectious Complications among 620 Consecutive Heart Transplant Patients at Stanford University Medical Center

Montoya, José G.; Giraldo, Luís Fernando Garcés; Efron, Bradley; Stinson, Edward B.; Gamberg, P.; Hunt, Sharon A.; Giannetti, Nadia; Miller, Joan; Remington, Jack S.

doi:10.1086/322733

Cited by 281 publications

(233 citation statements)

References 31 publications

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“…Montoya et al reported, in heart transplant, that main bacterial infection sites were the lungs and urinary tract [10]. In our study, however, the most observed episode of Table 4.…”

Section: Discussioncontrasting

confidence: 46%

Health care-related infections in solid organ transplants

et al. 2007

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The health care-related infections are well-known in a critical care setting, but reports of those infections in solid organ transplanted patients are scarce. We developed a study of retrospective cohort in a tertiary teaching hospital for 14 months. Eighty-one patients underwent solid organ transplants. The global incidence of health care-related infection was 42.0%. Fifteen percent of the cases were occurrences of surgical site infections, 14.0% pneumonias, 9.0% primary blood stream infections, 4.0% urinary tract infections and 2.0% skin infection. The most prevalent etiologic agents were K. pneumoniae (8.6%), P. aeruginosa (7.4%); A. baumannii (5.0%) and S. aureus (2.5%). Mortality was 18.0%, none of then related to health care infections. The high rate of those infections, mainly surgical site infections, suggests a demand for stricter measures to prevent and control health care-related infections.

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“…Montoya et al reported, in heart transplant, that main bacterial infection sites were the lungs and urinary tract [10]. In our study, however, the most observed episode of Table 4.…”

Section: Discussioncontrasting

confidence: 46%

Health care-related infections in solid organ transplants

et al. 2007

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“…The high-risk individuals of GNB infection are those with poor immunity resulted from chemotherapy, autoimmune disease, or immunosuppression treatment after transplantation (17,18). However, no prophylactic method for bacterial infection occurred is available.…”

Section: Discussionmentioning

confidence: 99%

Protection of Immuno-Compromised Mice from Lethal Infection of Klebsiella Pneumonia by rAAV2-BPI23-Fcγ1 Gene Transfer

Kong

et al. 2008

Cell Mol Immunol

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“…The MMF dose was modified or treatment was terminated depending on all available information such as leukopenia <4000 leukocytes/mm 3 and/or severe lymphopenia and in certain cases, of severe infection. In case of blood count normalization, the dose of MMF was either individually enhanced or MMF was reinitiated in lower doses under careful monitoring.…”

Section: Methodsmentioning

confidence: 99%

“…In the early period after orthotopic heart transplantation (HTx), patients are particularly vulnerable to rejection 1 and infectious complications 2,3 . Immunosuppressive and anti-infective drug prophylaxis consists of drugs with potentially myelotoxic effects.…”

Section: Introductionmentioning

confidence: 99%

Bone marrow suppression and associated consequences in patients after heart transplantation: A 6-year retrospective review

Pazderník¹,

Málek²,

Koudelková³

et al. 2015

BIOMED PAP

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Aims.To evaluate the incidence of bone marrow suppression and consequences of MMF dose adjustment in patients within the first year after heart transplantation. Methods. Group I (n=47) was treated with a regimen currently used in patients after heart transplantation (mycophenolatemofetil -MMF, valganciclovir -VGC and trimethoprim/sulfamethoxazole -TMP-SMX). Group II (n=47) received only MMF of potentially myelotoxic medications. The myelotoxic effect and need for dose modification were assessed. The incidence of rejections and infectious episodes associated with MMF adjustment were analyzed during the first 12 months in Group I.Results. There was a significantly greater proportion of patients with leukopenia (leukocyte count < 4 x 10^9/L) at 3 months after orthotopic heart transplantation in Group I compared with Group II (19.1% vs 2.1%; P = 0.02). The difference in lymphopenia (lymphocyte count < 0.8 x 10^9/L) at 3 months follow-up was highly significant (38.3 % vs 6.4 %; P = 0.0002). MMF was modified due to bone marrow suppression or severe infection in 63.8% patients in Group I and in only 8.5% of patients in Group II (P < 0.001). Reducing or stopping MMF was not associated with increased rejections. In Group I, at least 1 episode of higher degree cellular or humoral rejection occurred in 35% of patients with the standard MMF dosage compared with only 26% in patients with modified MMF (P = 0.0534). Conclusions. Addition of VGC+TMP-SMX to current immunosuppressive medication regimen in patients after heart transplantation is associated with significant lymphocytopenia and leukopenia. Importantly, modification of immunosuppressive prophylaxis (reducing or stopping MMF) leads to normalization of blood count without increased incidence of rejections.

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Infectious Complications among 620 Consecutive Heart Transplant Patients at Stanford University Medical Center

Cited by 281 publications

References 31 publications

Health care-related infections in solid organ transplants

Health care-related infections in solid organ transplants

Protection of Immuno-Compromised Mice from Lethal Infection of Klebsiella Pneumonia by rAAV2-BPI23-Fcγ1 Gene Transfer

Bone marrow suppression and associated consequences in patients after heart transplantation: A 6-year retrospective review

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