M. Bernabeu-wittel et al., Infectious complications from heart transplantation. Prospective study forthe first six years of a transplantation program, REV CLIN ES, 199(8), 1999, pp. 489-495
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.