Outcomes and Predictors of Early Infection after Heart Transplantation

Shultes, Kendall C.; Shuster, Jerrica E.; Micek, Scott T.; Vader, Justin; Balsara, Keki R.; Itoh, Akinobu; Tellor, Bethany

doi:10.1089/sur.2017.295

Cited by 10 publications

(9 citation statements)

References 21 publications

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“…In this study, the major cause of 30-day mortality was an infection in patients with pre-transplant RRT. Previous studies have reported that pre-transplant RRT was a major risk factor of post-transplant BSI in HT ( 2 , 25 ). Both use of RRT and MCS before HT would further increase the risk of BSI before and after HT ( 12 , 26 ).…”

Section: Discussionmentioning

confidence: 98%

Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation

et al. 2022

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End stage renal disease (ESRD) is a contraindication to isolated heart transplantation (HT). However, heart candidates with cardiogenic shock may experience acute kidney injury and require renal replacement therapy (RRT) and isolated HT as a life-saving operation. The outcomes, including survival and renal function, are rarely reported. We enrolled 569 patients undergoing isolated HT from 1989 to 2018. Among them, 66 patients required RRT before HT (34 transient and 32 persistent). The survival was worse in patients with RRT than those without (65.2% vs 84.7%; 27.3% vs 51.1% at 1- and 10-year, p < 0.001 and p = 0.012, respectively). Multivariate Cox analysis identified pre-transplant hyperbilirubinemia (Hazard ratio (HR) 2.534, 95% confidence interval (CI) 1.098–5.853, p = 0.029), post-transplant RRT (HR 5.551, 95%CI 1.280–24.068, p = 0.022) and post-transplant early bloodstream infection (HR 3.014, 95%CI 1.270–7.152, p = 0.012) as independent risk factors of 1-year mortality. The majority of operative survivors (98%) displayed renal recovery after HT. Although patients with persistent or transient RRT before HT had a similar long-term survival, patients with persistent RRT developed a high incidence (49.2%) of dialysis-dependent ESRD at 10 years. In transplant candidates with pretransplant RRT, hyperbilirubinemia should be carefully re-evaluated for the eligibility of HT whereas prevention and management of bloodstream infection after HT improve survival.

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Section: Discussionmentioning

confidence: 98%

Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation

et al. 2022

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“…Bacterial infections have become the most frequent and challenging infections in SOT recipients [2,13,14]. Among bacterial infections, BSI are those associated with the highest mortality rates, which can reach 30% in heart transplant patients [15] and 25% in lung transplanted patients [16].…”

Section: Discussionmentioning

confidence: 99%

“…Bloodstream infections (BSIs) represent a major complication of solid organ transplant (SOT) and are among the leading causes of morbidity and mortality in patients [1,2]. Overall, the rate of BSIs ranges from 8.6% to 26%, depending on transplantation type [3].…”

Section: Introductionmentioning

confidence: 99%

Bloodstream infection reduction rate within the first month after heart and lung transplant with broader spectrum antimicrobial prophylaxis

Seminari¹,

Silvestri²,

Matteo³

et al. 2020

Trends in Transplant

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Introduction: Bloodstream infections (BSIs) occur early in the post transplant period, the aim of this retrospective study was to evaluate whether a broather antimicrobial prophylaxis at transplant could be helpful in reducing BSI incidence. Method:All BSI episodes occurring considered as early (until 30 days after transplant) or late events (from 31days to 365 days after transplant) were recorded. Before October 1st, 2018, vancomycin was used as prophylaxis at transplant (period 1); after October 1st,2018 prophylaxis included vancomycin and piperacillin/tazobactam (period 2) or a targeted prophylaxis according to the colonization bacteria detected through rectal swab.Results: One-hundred-fifteen patients received a SOT during the study (77 in period 1 and 38 in period 2),73 (63.5%) heart recipients, and 42 (36.5%) lung recipients. Fifty-four BSI episodes were recorded in 41 patients (36.7%). Gram-negative bacteria were responsible for the majority of BSIs. Twenty-four patients died during the study timeframe (22%) (type of SOT: 18 heart, 6 lung transplanted patients), having a BSI was a risk factor for death (HR 5.2; 95% CI 2.1-12-5, p<0.001).BSIs in the first 30 days after transplant accounted for 48% of all events. Overall BSI incidence rate was 1.15 per 100 patient/days in the first 30 days after transplant; 1.49 per 100 patient/days in period 1 and 0.58 per 100 patient/days in period 2. The use of broader antimicrobial prophylaxis was associated with reduced BSI in period 2 compared to period 1 (HR 0.39; 95%CI 0.16-0.93, p=0.035); CKD was associated with increased BSI risk (HR 2.45; 95% CI 1.1-6, p=0.048). At multivariate analysis the risk of BSI still remained reduced in period 2 (HR 0.38; 95%CI 0.14-1, p=0.05). BSI incidence between 31 and 365 days after transplant was 0.15 per 100 patient/days, age remained associated to BSI in the late period at multivariate analysis. Discussion: Broader antimicrobial prophylaxis at transplant is an option to reduce BSI incidence in the first month after transplant.

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“…Multivariate analysis revealed that hypertension and pre‐operative eGFR were significant predictors of unplanned readmission, suggesting that pre‐operative hypertension and renal function are important variables for readmission. This indicates that cardiovascular and renal function affect factors leading to death or readmission in 1 year after heart transplantation (McAdams‐DeMarco et al, ; Shultes et al, ) and that medication‐induced complications due to immunosuppressant administration after transplantation influences readmission (Hunt & Haddad, ). Therefore, these findings could aid in the development of interventions for the prevention and reduction of unplanned readmission through intensive postoperative care management of patients with risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, disease-related factors include indication for heart transplantation (Doesch et al, 2010), pre-operative intensive care unit (ICU) and hospital admission (Ohe, 2012) and inotropic agent and medical device use (Weber et al, 2014). Lastly, therapeutic factors include haemodialysis (Shultes et al, 2018), cold ischaemic time (Ahn et al, 2017), pre-and postoperative laboratory data (Huang et al, 2008) and prescribed medication after the operation, such as immunosuppressants and cholesterol synthesis inhibitors (Kittleson & Kobashigawa, 2013;Kong, 2009).…”

Section: Introductionmentioning

confidence: 99%

Unplanned readmission of patients with heart transplantation in 1 year: A retrospective study

Kim

2019

Journal of Advanced Nursing

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Aim To investigate readmission rate and its association with patient characteristics to identify key risk factors associated with unplanned readmission in 1 year after heart transplantation. Background Unplanned readmission after heart transplantation due to complications affects patients’ quality of life and long‐term survival rate. Design A retrospective cohort study. Methods Individual, disease‐related and therapeutic characteristics were included from electronic medical records. Participants were 484 adult patients who underwent heart transplantation between 1992 ‐ 2016 at a tertiary hospital in Korea. Results A total of 204 patients underwent unplanned readmission. The most frequent causes were infection or rejection. Multivariate analysis revealed hypertension and pre‐operative estimated glomerular filtration rate to be risk factors for unplanned readmission. Conclusion Early screening educational programs and interventions based on recommended risk factors are needed to reduce the unplanned readmission rate of heart transplantation patients. Impact Nurses who care for heart‐transplanted patients should initially assess risk factors during the postoperative and recovery periods to reduce risk of readmission following surgery. These findings may contribute to early assessment criteria and development of discharge nursing education materials.

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Outcomes and Predictors of Early Infection after Heart Transplantation

Abstract: Prior mechanical circulatory support and the acute need for CRRT may predispose OHT patients to an infection early in the post-operative period. Evaluation of peri-operative antimicrobial prophylaxis, based on an individual center's resistance panels, may be warranted.

Cited by 10 publications

References 21 publications

Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation

Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation

Bloodstream infection reduction rate within the first month after heart and lung transplant with broader spectrum antimicrobial prophylaxis

Unplanned readmission of patients with heart transplantation in 1 year: A retrospective study

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