Background
Methods
Patient population and study design
Immunosuppressive and antimicrobial prophylaxis after transplantation
Clinical definitions
Statistical analysis
Results
Study population
No VAD (n = 84) | VAD (n = 35) | |
---|---|---|
Follow-up, years; mean (SD) | 1.38 (1.07) | 1.31 (1.06) |
Recipient age, years; mean (SD) | 47.9 (16.9) | 45.7 (16.7) |
Recipient gender, male; n (%) | 62 (73.8) | 28 (80) |
Donor age, years; mean (SD) | 41.3 (16.5) | 40.7 (15.0) |
Donor gender, male; n (%) | 48 (57.1) | 24 (68.6) |
Prior diabetes; n (%) | 15 (17.9) | 4 (11.4) |
BMI, kg/m2; mean (SD) | 24.4 (4.7) | 25.2 (4.8) |
Serum creatinine, umol/l; mean (SD) | 125.9 (66.0) | 103.3 (47.1) |
Underlying disease; n (%) | ||
- Cardiomyopathy - Ischemic - Congenital heart disease - Other | 41 (48.8) 23 (27.4) 5 (5.9) 15 (17.9) | 18 (51.4) 12 (34.3) 1 (2.9) 4 (11.4) |
Cold ischemia, min; mean (SD) | 151 (54.3) | 164 (54.4) |
Bypass time, min; mean (SD) | 168 (65.6) | 186 (71.1) |
Induction therapy; n (%) | ||
- Basiliximab - ATG - None | 7 (8.3) 71 (84.5) 6 (7.1) | 6 (17.1) 24 (68.6) 5 (14.3) |
Maintenance at discharge; n (%) | ||
- Tacrolimus - Cyclosporin - MMF/MPA - Azathioprine - Everolimus - Steroids | 28 (33.3) 39 (46.4) 63 (75.0) 21 (25.0) 9 (10.7) 74 (88.1) | 10 (28.6) 13 (37.1) 22 (62.9) 7 (20.0) 3 (8.6) 27 (77.1) |
Pre-transplant characteristics of patients with VAD
Characteristics | VAD infection n = 18 | No VAD infection n = 17 |
---|---|---|
Age, years; mean (SD) | 52.3 (9.7) | 39.1 (20) |
Gender, male; n (%) | 15 (83.3) | 14 (82.4) |
BMI, kg/m2; mean (SD) | 28.4 (6.1) | 22.9 (6) |
Median time from VAD implantation to transplantation, days; median (IQR) | 293.5 (121–593) | 101 (37.5-206) |
INTERMACS score; median (IQR) | 1.5 (1–4) | 2 (1–3) |
Creatinine, μmol/l; mean (SD) | 105.3 (58.6) | 90.9 (35.6) |
Type of VAD; n (%) | ||
- Heartmate® II - Berlin Heart® EXCOR - Heartware® - Thoratec® - Levitronics® | 9 (37.1) 6 (34.3) 1 (14.3) 2 (11.4) 0 (0.0) | 5 (29.4) 6 (35.3) 4 (23.5) 1 (5.8) 1 (5.8) |
Active infection at the time of transplant | 10/18 (55.5) | - |
Infections | VAD patients n = 18 |
---|---|
Total number of VAD-specific or related infectionsa | n = 43 |
VAD-specific infections; n (%) • Proteus mirabilis • Enterobacter spp. • Staphylococcus aureus • MSSA • MRSA • Coagulase-negative Staphylococci • Escherichia coli • ESBL • Serratia marcescens • Enterococcus faecalis • VRE • Other | 24 (55.8) 6 (13.9) 4 (9.3) 3 (7.0) 2 (4.7) 1 (2.3) 3 (7.0) 3 (7.0) 0 (0) 2 (4.7) 2 (4.7) 0 (0) 8 (18.6) |
VAD-related infections; n (%) • Staphylococccus aureus • MSSA • MRSA • Coagulase-negative Staphylococci • Enterobacter spp. • Proteus mirabilis • Escherichia coli • ESBL • Enterococcus spp. • VRE • Candida spp. • Other | 32 (74.4) 7 (16.3) 2 (4.7) 5 (11.6) 3 (7.0) 7 (16.3) 5 (11.6) 3 (7.0) 0 (0) 3 (7.0) 0 (0) 1 (2.3) 4 (9.3) |
Impact of VAD implantation on post-transplant outcomes
No VAD (n = 84) | VAD (n = 35) | |
---|---|---|
Patients with ≥1 post transplant bacterial/candida infection episode, n (%) | 39 (46.4) | 12 (34.3) |
Number of episodes of bacterial/candida infections per patient; mean (SD) | 0.83 (1.31) | 0.51 (0.82) |
Number of post-transplant bacterial/candida infections episodes | 70 | 18 |
Sites of bacterial/candida infections; n (%)a | ||
- Respiratory tract - Bacteremia - Urinary tract - Surgical site - Otherb | 18 (25.7) 11 (15.7) 12 (17.1) 17 (24.3) 17 (24.3) | 4 (22.2) 5 (27.7) 3 (16.7) 7 (38.9) 2 (11.1) |
Microorganisms; n (%) | ||
- Escherichia coli - Coagulase Negative Staphylococci - Staphylococcus aureus - Pseudomonas sp. - Clostridium difficile - Enterobacter sp. - Candida sp. - Polymicrobial - Other | 10 (14.3) 6 (8.6) 6 (8.6) 6 (8.6) 5 (7.1) 6 (8.6) 6 (8.6) 5 (7.1) 19 (27.1) | 2 (11.1) 1 (5.6) 1 (5.6) 0 2 (11.1) 2 (11.1) 1 (5.6) 3 (16.7) 7 (38.9) |
Viral infections | ||
- CMV infection - VZV infection - HSV infection | 31 (36.9) 8 (9.5) 15 (17.9) | 8 (22.9) 3 (8.6) 1 (2.9) |
Other fungal infections | ||
- Aspergillus spp.infection - Pneumocystis jiroveci pneumonia | 7 (8.3) 3 (3.6) | 1 (2.9) 0 (0.0) |
Length of stay after transplant, days; mean (SD) | 60.8 (65.0) | 82.9 (127.6) |
Patients with treated acute rejection, n (%) | 57 (67.9) | 22 (62.9) |
Survival; n (%) | 69 (82.1) | 29 (82.9) |
Bacterial and candida infection | All fungal infections | Viral infections | |||||||
---|---|---|---|---|---|---|---|---|---|
Hazard ratio | 95 % CI | p-value | Hazard ratio | 95 % CI | p-value | Hazard ratio | 95 % CI | p-value | |
Recipient agea | 0.89 | 0.67-1.19 | 0.43 | 1.30 | 0.77-2.21 | 0.32 | 0.91 | 0.68-1.20 | 0.49 |
Recipient male gender | 2.06 | 0.85-5.01 | 0.11 | 0.98 | 0.22-4.32 | 0.98 | 1.59 | 0.62-4.10 | 0.33 |
Donor agea | 1.03 | 0.81 – 1.31 | 0.81 | 1.10 | 0.74 – 1.63 | 0.64 | 0.92 | 0.70 – 1.20 | 0.54 |
Donor male gender | 1.88 | 0.91 – 3.89 | 0.09 | 0.76 | 0.27 – 2.20 | 0.62 | 0.50 | 0.23 – 1.06 | 0.07 |
VAD pre-transplant | 0.27b | 0.06-1.30 | 0.10 | ||||||
- Continuous-flow device | 0.94 | 0.38- 2.32 | 0.89 | 0.91 | 0.32 – 2.56 | 0.86 | |||
- Other device | 0.45 | 0.15 - 1.34 | 0.15 | 0.64 | 0.18 – 2.22 | 0.48 | |||
Diabetes | 1.48 | 0.69-3.20 | 0.32 | 2.74 | 0.87-8.57 | 0.08 | 2.01 | 0.82-5.31 | 0.12 |
Post-transplant cotrimoxazole prophylaxis | 0.29 | 0.15-0.57 | <0.001 | 1.04 | 0.36-3.01 | 0.95 | 1.03 | 0.49-2.17 | 0.94 |
Transplant center | |||||||||
Center A (ref.) | 1 | 1 | 1 | ||||||
Center B | 0.69 | 0.32 – 1.49 | 0.35 | 1.38 | 0.40-4.78 | 0.61 | 1.06 | 0.46-2.45 | 0.89 |
Center C | 0.55 | 0.23 – 1.31 | 0.18 | 0.28 | 0.04-1.78 | 0.18 | 0.50 | 0.18-1.44 | 0.20 |
Induction therapy | |||||||||
No induction(ref.) | 1 | 1 | 1 | ||||||
ATG | 1.01 | 0.35 – 2.96 | 0.98 | 0.18 | 0.02-1.37 | 0.10 | 1.20 | 0.34-4.25 | 0.78 |
Basiliximab | 1.57 | 0.42 – 5.92 | 0.50 | 0.40 | 0.03-5.58 | 0.50 | - | - | - |
Use of everolimus | 0.34 | 0.08 – 1.49 | 0.15 | 2.24 | 0.54-9.33 | 0.27 | 0.90 | 0.28-2.86 | 0.86 |