Ventricular assist devices as bridge to heart transplantation: impact on post-transplant infections View Full Text


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Article Info

DATE

2016-07-08

AUTHORS

Delphine Héquet, Georg Kralidis, Thierry Carrel, Alexia Cusini, Christian Garzoni, Roger Hullin, Pascal R. Meylan, Paul Mohacsi, Nicolas J. Mueller, Frank Ruschitzka, Piergiorgio Tozzi, Christian van Delden, Maja Weisser, Markus J. Wilhelm, Manuel Pascual, Oriol Manuel, Swiss Transplant Cohort Study (STCS)

ABSTRACT

BackgroundVentricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac transplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant infections in a nationwide cohort of heart transplant recipients.MethodsHeart transplant recipients included in the Swiss Transplant Cohort Study between May 2008 and December 2012 were analyzed. Cumulative incidence curves were used to calculate the incidence of bacterial or Candida infections (primary endpoint) and of other infections (secondary endpoint) after transplant. Cox regression models treating death as a competing risk were used to identify risk factors for the development of infection after transplant.ResultsOverall, 119 patients were included in the study, 35 with a VAD and 84 without VAD. Cumulative incidences of post-transplant bacterial or Candida infections were 37.7 % in VAD patients and 40.4 % in non-VAD patients. In multivariate analysis, the use of cotrimoxazole prophylaxis was the only variable associated with bacterial/Candida infections after transplant (HR 0.29 [95 % CI 0.15-0.57], p < 0.001), but presence of a VAD was not (HR 0.94, [95 % CI 0.38-2.32], p = 0.89, for continuous-flow devices, and HR 0.45 [0.15 – 1.34], p = 0.15, for other devices). Risk for post-transplant viral and all fungal infections was not increased in patients with VAD. One-year survival was 82.9 % (29/35) in the VAD group and 82.1 % (69/84) in the non-VAD group. All 6 patients in the VAD group that died after transplant had a history of pre-transplant VAD infection.ConclusionIn this nationwide cohort of heart transplant recipients, the presence of VAD at the time of transplant had no influence on the development of post-transplant infections. More... »

PAGES

321

Journal

TITLE

BMC Infectious Diseases

ISSUE

1

VOLUME

16

Author Affiliations

  • Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
  • Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
  • Clinic for Cardiovascular Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  • Department of Infectious Diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  • Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland
  • Department of Medicine, Service of Cardiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
  • Institute of Microbiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
  • Bern University Hospital and University of Bern, Bern, Switzerland
  • Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
  • Department of Cardiology, Cardiovascular Center, University Hospital, University of Zurich, Zurich, Switzerland
  • Department of Cardiovascular Surgery, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
  • Transplant Infectious Diseases Unit, University Hospitals Geneva, Geneva, Switzerland
  • Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
  • Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
  • Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
  • Infectious Diseases Service and Transplantation Center, University Hospital and University of Lausanne, BH 10/553, CHUV, Lausanne, Switzerland
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s12879-016-1658-0

    DOI

    http://dx.doi.org/10.1186/s12879-016-1658-0

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1012437319

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/27391967


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        "description": "BackgroundVentricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac transplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant infections in a nationwide cohort of heart transplant recipients.MethodsHeart transplant recipients included in the Swiss Transplant Cohort Study between May 2008 and December 2012 were analyzed. Cumulative incidence curves were used to calculate the incidence of bacterial or Candida infections (primary endpoint) and of other infections (secondary endpoint) after transplant. Cox regression models treating death as a competing risk were used to identify risk factors for the development of infection after transplant.ResultsOverall, 119 patients were included in the study, 35 with a VAD and 84 without VAD. Cumulative incidences of post-transplant bacterial or Candida infections were 37.7\u00a0% in VAD patients and 40.4\u00a0% in non-VAD patients. In multivariate analysis, the use of cotrimoxazole prophylaxis was the only variable associated with bacterial/Candida infections after transplant (HR 0.29 [95 % CI 0.15-0.57], p\u2009<\u20090.001), but presence of a VAD was not (HR 0.94, [95 % CI 0.38-2.32], p\u2009=\u20090.89, for continuous-flow devices, and HR 0.45 [0.15 \u2013 1.34], p\u2009=\u20090.15, for other devices). Risk for post-transplant viral and all fungal infections was not increased in patients with VAD. One-year survival was 82.9\u00a0% (29/35) in the VAD group and 82.1\u00a0% (69/84) in the non-VAD group. All 6 patients in the VAD group that died after transplant had a history of pre-transplant VAD infection.ConclusionIn this nationwide cohort of heart transplant recipients, the presence of VAD at the time of transplant had no influence on the development of post-transplant infections.", 
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    26 schema:description BackgroundVentricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac transplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant infections in a nationwide cohort of heart transplant recipients.MethodsHeart transplant recipients included in the Swiss Transplant Cohort Study between May 2008 and December 2012 were analyzed. Cumulative incidence curves were used to calculate the incidence of bacterial or Candida infections (primary endpoint) and of other infections (secondary endpoint) after transplant. Cox regression models treating death as a competing risk were used to identify risk factors for the development of infection after transplant.ResultsOverall, 119 patients were included in the study, 35 with a VAD and 84 without VAD. Cumulative incidences of post-transplant bacterial or Candida infections were 37.7 % in VAD patients and 40.4 % in non-VAD patients. In multivariate analysis, the use of cotrimoxazole prophylaxis was the only variable associated with bacterial/Candida infections after transplant (HR 0.29 [95 % CI 0.15-0.57], p < 0.001), but presence of a VAD was not (HR 0.94, [95 % CI 0.38-2.32], p = 0.89, for continuous-flow devices, and HR 0.45 [0.15 – 1.34], p = 0.15, for other devices). Risk for post-transplant viral and all fungal infections was not increased in patients with VAD. One-year survival was 82.9 % (29/35) in the VAD group and 82.1 % (69/84) in the non-VAD group. All 6 patients in the VAD group that died after transplant had a history of pre-transplant VAD infection.ConclusionIn this nationwide cohort of heart transplant recipients, the presence of VAD at the time of transplant had no influence on the development of post-transplant infections.
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