Korean Circ J.  2001 Aug;31(8):815-823. 10.4070/kcj.2001.31.8.815.

Clinical analysis on infections after cardiac transplantation

• Park JH
• Lee YJ
• Kang SJ
• Jang JS
• Song MG
• Kim YS
• Lee CW
• Hong MK
• Song JK
• Park SW
• Park SJ
• Kim JJ

• KMID: 2029570
• DOI: http://doi.org/10.4070/kcj.2001.31.8.815

Abstract

BACKGROUND
The heart transplantation is now accepted as a definite therapeutic modality in patients with terminal heart failure. With use of immunosuppressive agent, the incident of rejection deceased but risk of infection increased. Infection has been the most common cause of death in heart transplant patient, especially during the first year. The purpose of this study is to evaluate the infection of 91 patients who had heart transplantation at our hospital.
METHODS
Of the total 91 patients, there were 75 males and 16 females, and the mean age was 39.8+/-14.1 years ranged from 14 to 62 years. All patients were in NYHA functional class III or IV preoperatively. The most common underlying heart diseases were dilated cardiomyopathy(72/91). The mean follow-up duration was 36.4 months (range; 0.6 ~ 103 months) and 10 patients died during this period. RESULT: There were 35 patients with infections (early infections in 4 and late infections in 32). The most common infection was skin infection of herpes virus (15 cases). Pneumonia occurred in 8 patients and responded well to antibiotics. But multiple empyema developed in one patient with bacterial pneumonia despite of antibiotics, chest tube insertion was needed. There were 4 patients with tuberculosis, 2 with tuberculous pericardial effusion, 1 with pulmonary tuberculosis and 1 with miliary tuberculosis. Sepsis was noted in 3 patients, 2 with bacterial sepsis and 1 with candidial sepsis. They all died despite of antibiotic treatment. There were 2 cases with wound infections and 1 with perianal abscess, and 1 with aortitis with paraaortic abscess due to Aerococcus viridans. Two patients with cryptococcal meningitis were successfully treated with liposomal amphotericin B and oral fluconazole, one of them also had invasive aspergillosis. There were 6 cases with cytomegalovirus (CMV) disease. Three of them had CMV viremia , 2 had CMV disease ( retinitis and colitis) and 1 had viremia and disease.
CONCLUSION
There were 35 patients (38.5%) with infections and among then, 21 patients (23%) had one or more episodes of major infection. Infection was a major cause of death (30%) after heart transplantation. Careful control of infection is vital in the care of transplant recipients because infections result in increased morbidity and mortality.

Keyword

Heart transplantation; Infection

MeSH Terms

Abscess
Aerococcus
Amphotericin B
Anti-Bacterial Agents
Aortitis
Aspergillosis
Cause of Death
Chest Tubes
Cytomegalovirus
Empyema
Female
Fluconazole
Follow-Up Studies
Heart
Heart Diseases
Heart Failure
Heart Transplantation*
Humans
Male
Meningitis, Cryptococcal
Mortality
Pericardial Effusion
Pneumonia
Pneumonia, Bacterial
Retinitis
Sepsis
Skin
Transplantation
Tuberculosis
Tuberculosis, Miliary
Tuberculosis, Pulmonary
Viremia
Wound Infection
Amphotericin B
Anti-Bacterial Agents
Fluconazole