Outcomes of patients with infection related to a ventricular assist device after heart transplantation

Abstract

Background: Despite significant advances in durable mechanical support survival, infectious complications remain the most common adverse event after ventricular assist device (VAD) implantation and the leading cause of early death after transplantation. In this study, we aim to describe our local infectious epidemiology and review short-term survival and infectious incidence rates in the post-transplantation period and assess risk factors for infectious episodes after transplantation. Methods: Retrospective single-center study of all consecutive adult heart transplant patients from 2008 to 2017. Survival data were estimated and summarized using the Kaplan-Meier method. We quantified and evaluated the difference in the incidence rate between patients with and without infection using a Fine-Gray model. The outcome of interest is the time to first infection diagnosis with post-transplant death as the competing event.Results: Among 278 heart transplant patients, 74 (26.5%) underwent LVAD implantation. Twenty-one patients (28.3%) developed an infection while supported by an LVAD.When compared to patients supported by an LVAD without a preceding infection, BMI was significantly greater (31.2 vs 27.8 kg/m 2 , P = .03). Median follow-up post-transplantation was 3.01 years. Significant risk factors for the competing risk regression for infection after heart transplantation include LVAD infection (HR 1.94, [95% CI] 1.11-3.39, P = .020) and recipient COPD (HR 2.14, [95% CI] 1.39-3.32, P = .001) when adjusted for recipient age, gender, hypertension, diabetes mellitus, and body mass index. Conclusions:Patients with LVAD-related infection had a significantly increased risk of infectious complications after heart transplantation. Further research on the avoidance of induction agents and reduced maintenance immunosuppression in this patient population is warranted. K E Y W O R D Santibiotic prophylaxis, antibiotic:antibacterial, heart (allograft) function/dysfunction, infectious complications

Management and Outcome of Left Ventricular Assist Device Infections in Patients Undergoing Cardiac Transplantation

“…Posttransplant survival of a patient with pretransplant LVAD infection has been explored in several recent studies. Similar to our study findings, no significant difference was observed when compared with cases without an LVAD infection [ 19 ]. Therefore, active or suppressed LVAD infection should not dissuade or delay patients and physicians from proceeding with heart transplantation if an organ becomes available.…”

The Predictive Value of Changes in Body Mass Index for the Incidence of Device-Specific Infections in Patients With Implantable Left Ventricular Assist Devices

“…The present study focused on changes in the BMI during the initial period of hospitalization after LVAD implantation and showed that a reduction infectious complications even after heart transplantation. 21 The present study provides further evidence that a reduction in BMI during the initial period of hospitalization after LVAD implantation is independently associated with a higher incidence of LVAD-specific infection within 1 year after implantation. In particular, patients with a low serum albumin concentration at baseline may be at high risk of developing LVAD-specific infections when their BMI decreases.…”

Complications of left ventricular assist devices causing high urgency status on waiting list: impact on outcome after heart transplantation

“…The incidence was the highest in patients with LVAD infections and LVAD bleeding complications and T patients. While a correlation between LVAD infections and postoperative infective constellations might be mediated by systemic inflammation, a correlation with bleeding events and T group is not completely understood at present 10,27 . We can only suggest a role of the acquired von Willebrand syndrome, frequently observed in patients with prolonged durable MCS 28 …”

“…While a correlation between LVAD infections and postoperative infective constellations might be mediated by systemic inflammation, a correlation with bleeding events and T group is not completely understood at present. 10,27 We can only suggest a role of the acquired von Willebrand syndrome, frequently observed in patients with prolonged durable MCS. 28 Primary graft dysfunction is a common problem in HTx and associated with impaired survival.…”

“…This discrepancy to the global registry data may be caused by a higher prevalence of patients with severe LVAD complications due to longer pre‐HTx support time in the Eurotransplant region 3–5,7–9 . Patients with severe complications are more compromised while undergoing HTx, which increases the risk of perioperative morbidity and mortality 7,10–12 …”