Document Detail


Infectious complications in extended criteria heart transplantation.
MedLine Citation:
PMID:  18971094     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We have previously shown that extended criteria heart transplant recipient mortality is higher than standard list mortality, but this is not associated with an increased incidence of either primary graft dysfunction or acute rejection. We hypothesized that other adverse outcomes, principally determined by recipient characteristics, occur at a higher rate in extended criteria recipients. METHODS: A retrospective review of adult heart transplant recipients was conducted at Duke University Medical Center between January 2000 and July 2007. Infectious complications considered risk factors for recipient mortality were identified. In addition, the incidence of these complications was compared between standard and alternate list recipients. RESULTS: Infectious complications, including pneumonia, bacteremia and sepsis, were significant predictors of overall mortality (pneumonia hazard ratio 4.2 [95% CI 2.5 to 7.0], bacteremia hazard ratio 3.0 [95% CI 1.9 to 4.9], sepsis hazard ratio 6.0 [95% CI 3.6 to 10.2]). In addition, pneumonia occurred at a significantly higher rate in extended criteria (EC) than in standard list (SL) patients (27% vs 13%, p = 0.005), and bacteremia and sepsis demonstrated a trend toward higher occurrence in EC patients (36% vs 25%, p = 0.076, and 15% vs 8%, p = 0.114, respectively). In contrast, severe acute cellular rejection (ISHLT Grade >/=3A) was not a predictor of mortality, and had a similar incidence in both groups. Finally, although overall survival among patients in the SL group was not influenced by the occurrence of a major infectious complication, survival in the extended criteria group was significantly impacted by major infectious complications (p < 0.001). CONCLUSIONS: Infectious complications may account for decreased survival in extended criteria heart transplant recipients.
Authors:
Keshava Rajagopal; Brian Lima; Rebecca P Petersen; Rachel G Mesis; Mani A Daneshmand; Anthony Lemaire; G Michael Felker; Adrian F Hernandez; Joseph G Rogers; Andrew J Lodge; Carmelo A Milano
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Publication Detail:
Type:  Journal Article     Date:  2008-10-01
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  27     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-30     Completed Date:  2009-02-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1217-21     Citation Subset:  IM    
Affiliation:
Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bacteremia / epidemiology
Cardiomyopathies / complications
Chronic Disease
Female
Heart Transplantation / adverse effects*,  mortality
Hepatitis B / complications
Hepatitis C / complications
Humans
Infection / epidemiology*,  mortality
Male
Middle Aged
Postoperative Complications / epidemiology*,  mortality
Proportional Hazards Models
Retrospective Studies
Risk Factors
Stroke / complications

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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