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

被引:1
|
作者
Chen, Jeng-Wei [1 ,2 ]
Chou, Heng-Wen [1 ,2 ]
Chou, Nai-Kuan [1 ]
Wang, Chih-Hsien [1 ]
Chi, Nai-Hsin [1 ]
Huang, Shu-Chien [1 ]
Yu, Hsi-Yu [1 ]
Chen, Yih-Sharng [1 ]
Hsu, Ron-Bin [1 ]
机构
[1] Natl Taiwan Univ, Natl Taiwan Univ Hosp, Div Cardiovasc Surg, Dept Surg,Coll Med, Taipei, Taiwan
[2] Natl Taiwan Univ, Grad Inst Clin Med, Coll Med, Taipei, Taiwan
关键词
bloodstream infection; heart transplantation; survival; RISK-FACTORS; RECIPIENTS; COMPLICATIONS; EPIDEMIOLOGY; MANAGEMENT; OPTIMIZE;
D O I
10.1111/tid.13834
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background Active bloodstream infection (BSI) is a contraindication for heart transplantation (HT). However, some critical patients with BSI may undergo HT as a life-saving 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. In-hospital 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.
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页数:11
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