Post Transplanted Infective Endocarditis.

Masutani, Motomaru; Ikeoka, Kiyomitsu; Sasaki, Ryoutarou; Nagasawa, S; Kawashima, Seinosuke; Mitani, Yorihisa; Fujitani, Kazumasa; Iwasaki, Tadaaki; Sawada, Yukio; Uematsu, Kazuyoshi

doi:10.2169/internalmedicine1962.30.458

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…In contrast, in the immunosuppressed kidney transplant patients, the distribution of pathogens seems to be much wider, and also includes uncommon opportunistic infections as well as common, community‐acquired ones. In additional, fungal endocarditis was over‐represented in the cases described above, diagnosed in 16% of cases compared to only 2% of IE cases in the general population . The prognosis seems to be worse in fungal rather than in bacterial IE, which is expressed in higher need of heart surgery during the acute infection (7/12 patients, 60%), and higher mortality rate (7/12, 60%).…”

Section: Discussionmentioning

confidence: 92%

“…In 10 (14%) of the cases, the pathogen was isolated from a vegetation specimen taken either during heart surgery or autopsy. The stratification of the isolated pathogens is shown in Table …”

Section: Literature Reviewmentioning

confidence: 99%

“…Endocarditis involved the left side of the heart in 66 cases (89%) and the right side in 6 (8%); two cases were defined as mural IE. The stratification of involved heart structures is shown in Table . Only five patients (7%) had a known preexisting valvular disease: rheumatic heart disease in two, a prosthetic valve in two, and aortic stenosis in one.…”

Section: Literature Reviewmentioning

confidence: 99%

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Infective endocarditis in the setting of renal transplantation: Case report and review of the literature

Agmon

Goldberg

Cohen

et al. 2017

Transplant Infectious Dis

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The potent immunosuppressive drugs used by transplant recipients place them at risk of infections. Data on infective endocarditis (IE) in the setting of renal transplantation (RT) are sparse. We describe a 36-year-old woman referred to a tertiary medical center for evaluation of elevated creatinine levels 1 month after a second RT. Work-up revealed the presence of all four of Duke's criteria: fever, persistent bacteremia, new-onset tricuspid regurgitation, and masses suspected to be vegetation attached to the tricuspid annulus. Symptoms resolved with antibiotic treatment and fluids. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed hypermetabolic absorption in the femoral vascular graft that had been used for hemodialysis prior to transplantation. The graft was removed by open surgery, and the patient was discharged home in good condition with continued antibiotic treatment. Review of the literature yielded 73 previously reported cases of IE in renal transplant recipients. Several differences were noted from IE in the general population: lower male predominance, younger age (<60 years), absence in most cases of a preexisting structural cardiac anomaly, and more variable causative pathogens. Our case also highlights the importance of FDG-PET/CT for detecting the source of IE and alerts clinicians to the sometimes unexpected course of the disease in renal transplant recipients.

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Section: Discussionmentioning

confidence: 92%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Infective endocarditis in the setting of renal transplantation: Case report and review of the literature

Agmon

Goldberg

Cohen

et al. 2017

Transplant Infectious Dis

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“…In a review of 14 reported cases of endocarditis, bacterial endocarditis occurred in 11 patients (78.5%), and fungal endocarditis was found in three cases (21%). Three cases were caused by S. aureus , two by Candida albicans , two by Corynebacterium species, and one each by Aspergillus species, Clostridium ramosum , Streptococcus viridans , Nocardia asteroides , vancomycin‐resistant enterococci, Erysipelothrix rhusiopathiae , and Brucella melitensis (4, 7–16). Klebsiella pneumoniae and Streptococcus bovis endocarditis in renal transplant recipients have also been reported (17, 18).…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of Staphylococcus aureus bacterial endocarditis in a renal transplant recipient

D'Cunha

Davenport

Fisher

2003

Transplant Infectious Dis

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We report the successful treatment of Staphylococcus aureus endocarditis in a renal transplant recipient with preservation of his renal allograft. A 44-year-old man presented to the emergency room with sudden onset of fevers and rigors 7 weeks after renal transplantation. Infective endocarditis was diagnosed by Duke's Criteria (Durack et al. New criteria for the diagnosis of infective endocarditis. Am J Med 1994: 96: 200-209) with multiple positive blood cultures for S. aureus and a mitral valve vegetation on transesophageal echocardiogram. He was treated with intravenous antibiotics for 6 weeks with continuation of his immunosuppression. He has remained clinically stable for over 5 years. Although the treatment of S. aureus endocarditis in immunosuppressed transplant patients has traditionally resulted in loss of their allograft, prompt diagnosis and appropriate antibiotics with continued immunosuppressive therapy resulted in a successful outcome and allograft preservation in this case.

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“…To our knowledge, there has been no homograft transplantation in liver-transplanted patients. In a review of the literature we could not find an exact percentage of incidence of heart valve operations in pre-or post-transplant patients; we did, however, find that there is a higher incidence of marantic endocarditis [4] and bacterial endocarditis [6] in post-transplant patients. Complications of "nonhomograft" valves jeopardize transplanted patients because of a higher thromboembolic complication rate and a fives times higher risk of prosthetic valve endocarditis in the first 9 postoperative months [l].…”

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confidence: 86%

Homograft replacement of the aortic valve after liver transplantation

et al. 1993

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Sir: Endocarditis can be a severe long-term complication that is associated with a high mortality rate in transplanted patients. Valve replacement can be performed either with a bioprosthetic valve (as is done in our department when a patient is over 70 years of age) or with a mechanical replacement device (when the patient is less than 70 years of age) or a homograft (in patients younger than 70) in aortic position. Homografts have several advantages over other devices, namely: (1) there is no need for anticoagulation;(2) there is no noise, which patients often find annoying;(3) there is longer durability; and (4) there is a lower incidence of endocarditis [3,8] with, consequently, a lower incidence of reoperation.We report on a 62-year-old man who underwent a liver transplantation in April 1990 because of hepatocellulary carcinoma. He had been maintained on a triple immunosuppressive therapy. The patient was in good health and had no complications after the operation. In September 1990, however, the patient experienced an onset of fatigue, chest pain, lower leg edemas, and increasing dyspnea. In October 1991 he was admitted to a hospital with congestive heart failure and bilateral pleural effusions. Conservative treatment did not result in any significant improvement, and so there was further evaluation. Cardiac catheterization was performed; this revealed combined aortic valve incompetence grade 111 and stenosis grade 1-11, mitral valve incompetence grade I1 with no coronary stenoses. The transplanted liver showed normal laboratory parameters.On 24 November 1991 cardiac surgery was performed with a cryopreserved aortic homograft. This was implanted according to the technique described by Ross and colleagues [7]. The postoperative course was uneventful and immunosuppression was continued. Postoperative echocardiography showed regular homograft valve function. Postoperative serial liver function tests were also performed. Except for once, on the 2nd day, the direct bilirubin in serum increased up to 1.56 mg/dl; all liver tests showed normal parameters.Nine months have elapsed since the aortic valve replacement. We had two follow-up check-ups, at 3 and 6 months post-transplantation. Both times echocardiography (valve incompetence grade I), red and white blood count, and X-rays of the chest showed no pathologic findings. The patient is clinically in class I, according to the New York Heart Association. Since the valve replacement there have not been any episodes of endocarditis and no further invasive procedures. The post-transplant follow-up is generally not done in our hospital, so we contacted the clinic in which this is performed. The patient had his last follow-up examination in July 1992. All posttransplant liver parameters were within the normal ranges.Heart valve operations have been performed after cadaver renal transplantation in many cases [5, 91. To our knowledge, there has been no homograft transplantation in liver-transplanted patients. In a review of the literature we could not find an exact percent...

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Post Transplanted Infective Endocarditis.

Cited by 7 publications

References 7 publications

Infective endocarditis in the setting of renal transplantation: Case report and review of the literature

Infective endocarditis in the setting of renal transplantation: Case report and review of the literature

Successful treatment of Staphylococcus aureus bacterial endocarditis in a renal transplant recipient

Homograft replacement of the aortic valve after liver transplantation

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