Impact of pre‐transplant bloodstream infection on clinical outcomes after heart transplantation

Abstract

Background: Active bloodstream infection (BSI) is a contraindication for heart transplantation (HT). However, some critical patients with BSI may undergo HT as a lifesaving procedure. We aimed to investigate the impact of pre-transplant BSI on the clinical outcomes after HT. Methods:We enrolled 511 consecutive patients who underwent HT between 1999 and 2019. Patients were divided into two groups based on the presence of BSI within 30 days preoperatively. Forty-three patients (8.4%) with BSI who were clinically stable and had no metastatic infection were considered for HT on an individual basis. Inhospital mortality, incidence of early postoperative BSI, length of postoperative hospital stays, and long-term survival were compared between the groups. Logistic and Cox regression analyses were performed to identify risk factors for in-hospital and 1-year mortality.Results: Patients with pre-transplant BSI had a high incidence of previous cardiopulmonary resuscitation, pre-transplant ventilator use, mechanical circulatory support use, renal replacement therapy, United Network for Organ Sharing status 1A, and a prolonged preoperative hospital waiting period. The in-hospital mortality rate was higher in patients with pre-transplant BSI (21% vs. 12%, p = .081), and the mortality rate was very high (33.3%) for those with BSI 0-15 days before HT. In addition, patients with pre-transplant BSI had a significantly longer postoperative hospital stay than patients in the control group. However, long-term survival was similar in both groups.Conclusions: Although pre-transplant BSI was associated with higher in-hospital mortality and prolonged postoperative hospital stay, patients who survived the early period had a similar long-term prognosis.

Impact of Previous Conventional Cardiac Surgery on the Clinical Outcomes After Heart Transplantation

“…Infection remained the leading cause of mortality in both groups in this study. Our previous research found that post-transplant dialysis and early bloodstream infection contributes to a 5.5-fold and 3.43-fold increase in early mortality, respectively [ 18 , 21 ]. In the present study, the PCCS group exhibited a higher incidence of certain factors, namely, post-transplant ECMO support (29%), delayed sternum closure (31%), early bloodstream infection (18%), and dialysis (41%).…”

“…After surgery, sternal closure may be delayed for 24 h if adequate hemostasis is not achieved. Furthermore, immunosuppressant and desensitization protocols were followed as usual, based on previous publications [ 18 – 21 ].…”