Changing trends in infectious disease in heart transplantation
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Changing trends in infectious disease in heart transplantation. / Haddad, François; Deuse, Tobias; Pham, Michael; Khazanie, Prateeti; Rosso, Fernando; Luikart, Helen; Valantine, Hannah; Leon, Sebastian; Vu, Thu A; Hunt, Sharon A; Oyer, Philip; Montoya, Jose G.
in: J HEART LUNG TRANSPL, Jahrgang 29, Nr. 3, 03.2010, S. 306-315.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Changing trends in infectious disease in heart transplantation
AU - Haddad, François
AU - Deuse, Tobias
AU - Pham, Michael
AU - Khazanie, Prateeti
AU - Rosso, Fernando
AU - Luikart, Helen
AU - Valantine, Hannah
AU - Leon, Sebastian
AU - Vu, Thu A
AU - Hunt, Sharon A
AU - Oyer, Philip
AU - Montoya, Jose G
PY - 2010/3
Y1 - 2010/3
N2 - BACKGROUND: During the past 25 years, advances in immunosuppression and the use of selective anti-microbial prophylaxis have progressively reduced the risk of infection after heart transplantation. This study presents a historical perspective of the changing trends of infectious disease after heart transplantation.METHODS: Infectious complications in 4 representative eras of immunosuppression and anti-microbial prophylaxis were analyzed: (1) 38 in the pre-cyclosporine era (1978-1980), (2) 72 in the early cyclosporine era (1982-1984), where maintenance immunosuppression included high-dose cyclosporine and corticosteroid therapy; (3) 395 in the cyclosporine era (1988-1997), where maintenance immunosuppression included cyclosporine, azathioprine, and lower corticosteroid doses; and (4) 167 in the more recent era (2002-2005), where maintenance immunosuppression included cyclosporine and mycophenolate mofetil.RESULTS: The overall incidence of infections decreased in the 4 cohorts from 3.35 episodes/patient to 2.03, 1.35, and 0.60 in the more recent cohorts (p < 0.001). Gram-positive bacteria are emerging as the predominant cause of bacterial infections (28.6%, 31.4%, 51.0%, 67.6%, p = 0.001). Cytomegalovirus infections have significantly decreased in incidence and occur later after transplantation (88 +/- 77 days, pre-cyclosporine era; 304 +/- 238 days, recent cohort; p < 0.001). Fungal infections also decreased, from an incidence of 0.29/patient in the pre-cyclosporine era to 0.08 in the most recent era. A major decrease in Pneumocystis jiroveci and Nocardia infections has also occurred.CONCLUSIONS: The overall incidence and mortality associated with infections continues to decrease in heart transplantation and coincides with advances in immunosuppression, the use of selective anti-microbial prophylaxis, and more effective treatment regimens.
AB - BACKGROUND: During the past 25 years, advances in immunosuppression and the use of selective anti-microbial prophylaxis have progressively reduced the risk of infection after heart transplantation. This study presents a historical perspective of the changing trends of infectious disease after heart transplantation.METHODS: Infectious complications in 4 representative eras of immunosuppression and anti-microbial prophylaxis were analyzed: (1) 38 in the pre-cyclosporine era (1978-1980), (2) 72 in the early cyclosporine era (1982-1984), where maintenance immunosuppression included high-dose cyclosporine and corticosteroid therapy; (3) 395 in the cyclosporine era (1988-1997), where maintenance immunosuppression included cyclosporine, azathioprine, and lower corticosteroid doses; and (4) 167 in the more recent era (2002-2005), where maintenance immunosuppression included cyclosporine and mycophenolate mofetil.RESULTS: The overall incidence of infections decreased in the 4 cohorts from 3.35 episodes/patient to 2.03, 1.35, and 0.60 in the more recent cohorts (p < 0.001). Gram-positive bacteria are emerging as the predominant cause of bacterial infections (28.6%, 31.4%, 51.0%, 67.6%, p = 0.001). Cytomegalovirus infections have significantly decreased in incidence and occur later after transplantation (88 +/- 77 days, pre-cyclosporine era; 304 +/- 238 days, recent cohort; p < 0.001). Fungal infections also decreased, from an incidence of 0.29/patient in the pre-cyclosporine era to 0.08 in the most recent era. A major decrease in Pneumocystis jiroveci and Nocardia infections has also occurred.CONCLUSIONS: The overall incidence and mortality associated with infections continues to decrease in heart transplantation and coincides with advances in immunosuppression, the use of selective anti-microbial prophylaxis, and more effective treatment regimens.
KW - Adult
KW - Anti-Bacterial Agents/therapeutic use
KW - Antiviral Agents/therapeutic use
KW - Bacterial Infections/epidemiology
KW - Cohort Studies
KW - Communicable Diseases/epidemiology
KW - Female
KW - Heart Diseases/surgery
KW - Heart Transplantation/immunology
KW - Humans
KW - Immunosuppressive Agents/therapeutic use
KW - Incidence
KW - Male
KW - Middle Aged
KW - Mycoses/epidemiology
KW - Opportunistic Infections/epidemiology
KW - Postoperative Complications/epidemiology
KW - Retrospective Studies
KW - Virus Diseases/epidemiology
U2 - 10.1016/j.healun.2009.08.018
DO - 10.1016/j.healun.2009.08.018
M3 - SCORING: Journal article
C2 - 19853478
VL - 29
SP - 306
EP - 315
JO - J HEART LUNG TRANSPL
JF - J HEART LUNG TRANSPL
SN - 1053-2498
IS - 3
ER -
