INFECTIOUS COMPLICATIONS AFTER HEART-TRAN SPLANTATION - THE LAUSANNE EXPERIENCE

Infectious complications, a major cause of morbidity and mortality aft er heart transplantation, were reviewed in 49 heart transplant patient s at Lausanne. The follow-up lasted 32 months on average. 43 patients (88%) presented 108 infections (2.20 episodes of infection/patient). 3 8 severe infections (0.78 episodes/patient) were diagnosed in 27 patie nts (55%). 2 of the 9 deaths which occurred were due to infection. The viruses, principally of the herpes group, were responsible for 37% of all the infections, and bacteria for 28%. About a third of the viral and bacterial infections were severe. The other documented infections were caused by fungi (13%), which were most often responsible for supe rficial infections, and rarely by protozoa (5%). Finally, in 17% of in fectious episodes, the pathogen could not be identified. Cytomegalovir us was the pathogen the most frequently responsible in severe infectio ns. The highest incidence of infections occurred during the first 2-3 months after transplantation and was reduced considerably after the 6t h month. The distribution of different pathogens was related to specif ic periods after the transplant. Our results confirm that infection is a major complication of heart transplantation. Clinical and prophylac tic aspects of some infections are reviewed.