Outcomes and Predictors of Early Infection after Heart Transplantation

Background: Limited data exist on the incidence and outcome of early infection after orthotopic heart transplantation (OHT). The purpose of this study was to describe characteristics and outcomes of OHT recipients with an early infection and to identify predictors of such infections. Methods: This retrospective, single-center study included patients greater than 18 years of age who underwent OHT from February 2009 to May 2014 and had an infection within 30 days of transplantation. Patient demographics, clinical variables, and outcomes were collected. Multivariable logistic regression was performed to identify independent predictors of infection. Results: Of the 172 eligible OHT recipients, 51 (29.7%) had an early infection. The median time to diagnosis was five days, with gram-negative organisms being slightly more common (58.2%). No differences in mortality rate, rejection, or re-admission were found between the groups. Longer durations of mechanical ventilation and lengths of stay were found in the infection group (p < 0.001). Patients with an early infection also had a higher incidence of mechanical circulatory support, history of drive-line infection, longer duration of mechanical ventilation, continuous renal replacement therapy (CRRT), and delayed chest closure (p < 0.05 for all). Pre-OHT left-ventricular assist device (adjusted odds ratio [AOR] 2.53; 95% confidence interval [CI] 1.015-6.286; p < 0.046), pre-OHT extracorporeal membrane oxygenation (AOR 14.10; 95% CI 1.38-150.5; p = 0.026) and post-OHT CRRT (AOR 3.98; 95% CI 1.67-9.52; p = 0.002) were found to be independent risk factors for an early infection. A total of 90% of the available susceptibility panels for the gram-negative isolates (26/29) were resistant to the standard peri-operative cephalosporin given. Conclusions: Prior mechanical circulatory support and the acute need for CRRT may predispose OHT patients to an infection early in the post-operative period. Evaluation of peri-operative antimicrobial prophylaxis, based on an individual center's resistance panels, may be warranted.