Infectious complications from heart transplantation. Prospective study forthe first six years of a transplantation program

Objective. To study the infectious complications, mortality, and associated factors in heart transplant recipients. Methods. Prospective study of the first 69 heart transplantations performed from January 1991 until December 1996 in a university hospital. Descriptio n of clinical features of infectious complications during the first year af ter transplantation. Univariate and multivariate analyses of the risk facto rs associated with mortality and development of infectious complications. Results. Seventy-three percent of patients had at least one infectious comp lication; the incidence was 1.13 episodes per patient-year. The etiology of complications was bacterial (50%), viral (31%), Pneumocystis carinii (5%), fungal (4%), and protozoal (4%). The opportunist organisms accounted for 4 2% of cases. Pneumonia was the most common complication (28%), followed by mucocutaneous herpetic reactivation (19%), bacteremia (13%), urinary tract infection (13%), cytomegalovirus disease (11.5%), pleural empyema (5%) and surgical wound infection (5%), Nosocomial pneumonia accounted for 50% of ca ses. Gramnegative rods accounted for 41% of pneumonia cases. A total of 62. 5% of deaths were directly related to infectious complications. Factors ind ependently associated with mortality were hospital origin at transplantatio n (RR = 4.5 [2-9], p = 0.034), development of infectious complications in t he post-heart transplantation period (RR = 3.2 [1.2-12], p = 0.04) and a mo re prolonged hospital stay at ICU (p = 0.0004). The factor which was indepe ndently associated with the development of infectious complications was one or more severe episodes of acute rejection (RR = 1.5 [1.1-2.2], p = 0.04). Patients who developed infectious complications had a more prolonged accum ulated annual hospital stay (p = 0.004) than those without infectious compl ications. Conclusions. Infectious complications are very common, prolong hospital sta y, and are the first cause of mortality during the first year after transpl antation. Bacteria are the most common etiology and pneumonia is the most c ommon infection.