INFECTION AFTER HEART-TRANSPLANTATION - A MULTIINSTITUTIONAL STUDY

The incidence, causes, and impact of acute infection were analyzed amo ng 814 consecutive patients from 24 institutions undergoing primary he art transplantation between January 1, 1990, and June 30, 1991, with m ean follow-up of 8.2 months (range 0 to 18 months). Sixty-nine percent of the patients had no infections during the follow-up, whereas 31% o f patients had one or more infection episodes. The cumulative incidenc e of infections per patient was 0.41 at 3 months, 0.55 at 6 months, an d 0.62 at 12 months after transplantation. Bacterial and viral infecti ons were most common (47% and 41% of infections), with fungi and proto zoa accounting for 12%. Overall mortality per infection was 13%, but m ortality with fungal infections was higher (36%, p < 0.0001). The most common organ infected was the lung, with a mortality of 23%. The prob ability of infection by 12 months was higher when OKT3 or antithymocyt e globulin induction therapy was used (41% versus 35%, p = 0.01). The single most frequent infecting organism was cytomegalovirus, accountin g for 26% of all infections. The probability of cytomegalovirus infect ion by 12 months was increased with a cytomegalovirus-positive donor a nd cytomegalovirus-negative recipient (27% versus 15% in all others, p < 0.0001) and with the use of OKT3 or antithymocyte globulin inductio n therapy (19% versus 12% without induction therapy, p = 0.07). Infect ion remains the leading cause of death after heart transplantation. Th e hazard function of likelihood of developing each type of infection a t various times after transplantation, as well as response to therapy, are discussed.