Purpose: to estimate the frequency and risk factors of infectious episodes (IEs) development early-term after heart transplantation (HTx).
Materials and Methods: From January 2010 to January 2020 we performed 140 orthotopic HTx (mean age - 47±14 year-old; 104 – male, 36 – female), 13% (n=18: n=3 - underwent an implantation of 2 MCSs) of them were bridged to transplant with the following mechanical circulatory support (MCS): ECMO (n=12), Berlin Heart “EXCOR” (n=8), LVAD (n=1). Most of recipients (71%, n=99) were awaiting HTx in heart failure (HF) department (n=83) or ICU (n=16) while others (29%, n=41) have been discharged from a hospital and followed-up in outpatient HF department. And 34 patients had IEs (n=13 – bacterial pneumonia, n=5 – bronchitis) while awaiting HTx (30 days prior to HTx) in inpatient department. Cefuroxime was used as a surgical antimicrobial prophylaxis in 85% (n=119) cases. Recipients were managed with triple-drug immunosuppression: tacrolimus, mycophenolic acid, steroids and induction (n=116 – Basiliximab, n=20 – Thymoglobulin). As prophylaxis of infections we prescribed all of them: Valgancyclovir (since 10th post-transplant day), Trimethoprim/Sulfamethoxazole and Nystatin. We retrospectively analyzed outcomes in ICU, the frequency of IEs development and the mortality rate early-term after HTx (30 days).
Results: After HTx most of patients were on ventilator support for about 1-2 days (79%, n=110) and spent in ICU than 10 days (65%, n=91), including 7,9% (n=11) of those who required post-transplant ECMO implantation due to right heart failure (RHF). IEs (n=97) developed in 56% (n=78) of recipients: 71% (n=69) – were bacterial, 27% (n=26) – fungal and 2% (n=2) – viral. The following IEs were diagnosed: pneumonia (n=29: n=3 - Aspergillus fumigatus), acute bronchitis (n=24), rhinopharyngitis/frontal sinusitis (n=5), urinary tract infection (n=27), orchiepididymitis (n=2) and others (n=10). IEs were caused by Klebsiella pneumonia (n=26), Pseudomonas aeruginosa (n=14), Enterococcus faecalis (n=6), Streptococcus Spp. (n=5), Enterobacter Sp. (n=2) etc. According to blood results of polymerase chain reaction (PCR), CMV was positive in 40 patients and EBV – in 37 without any other symptoms. In dynamic PCR was checked in all recipients. We found positive correlations between awaiting HTx in ICU department and pneumonia post-transplant development (r=0.356; p<0.001); between long stay on ventilator support and fungal infections (r=0.381; p=0.002) and pneumonia development (r=0.0547; p<0.001). In addition, 13 (9,3%) of patients died during 30 days after HTx and 2 more – before turning 2 months; their death was associated with infectious complications and sepsis in 60% (n=9).
Conclusion: During 30 days after HTx IEs developed in 56% of recipients with a prevalence of bacterial infections (71%) associated with Klebsiella pneumonia or Pseudomonas aeruginosa. Most frequent infectious locations were respiratory and urinary tracts.