BACKGROUND: Heart transplant (HT) recipients are at risk for invasive fungal disease (IFD), a morbid and potentially fatal complication. METHODS: We performed a retrospective cohort study to evaluate the incidence and risk factors for IFD in HT recipients from 1995 to 2012 at a single center. IFD cases were classified as proven or probable IFD according to current consensus definitions of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. We calculated IFD incidence rates and used Cox proportional hazards models to determine IFD risk factors. RESULTS: Three hundred sixty patients underwent HT during the study period. The most common indications were dilated (39%) and ischemic (37%) cardiomyopathy. There were 23 (6.4%) cases of proven (21) or probable (2) IFD, for a cumulative incidence rate of 1.23 per 100 person-years (95% CI 0.78 to 1.84). Candida (11) and Aspergillus (5) were the most common etiologic fungi. Thirteen cases (56%) occurred within 3 months of HT, with a 3-month incidence of 3.8% (95% CI 2.2 to 6.4). Delayed chest closure (HR 3.3, 95% CI 1.4 to 7.6, p = 0.01) and the addition of OKT3, anti-thymocyte globulin or daclizumab to standard corticosteroid induction therapy (HR 2.7, 95% CI 1.1 to 6.2, p = 0.02) were independently associated with an increased risk of IFD. CONCLUSIONS: IFD incidence was greatest within the first 3 months post-HT, largely reflecting early surgical-site and nosocomial Candida and Aspergillus infections. Patients receiving additional induction immunosuppression or delayed chest closure were at increased risk for IFD. Peri-transplant anti-fungal prophylaxis should be considered in this subset of HT recipients.
BACKGROUND: Heart transplant (HT) recipients are at risk for invasive fungal disease (IFD), a morbid and potentially fatal complication. METHODS: We performed a retrospective cohort study to evaluate the incidence and risk factors for IFD in HT recipients from 1995 to 2012 at a single center. IFD cases were classified as proven or probable IFD according to current consensus definitions of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. We calculated IFD incidence rates and used Cox proportional hazards models to determine IFD risk factors. RESULTS: Three hundred sixty patients underwent HT during the study period. The most common indications were dilated (39%) and ischemic (37%) cardiomyopathy. There were 23 (6.4%) cases of proven (21) or probable (2) IFD, for a cumulative incidence rate of 1.23 per 100 person-years (95% CI 0.78 to 1.84). Candida (11) and Aspergillus (5) were the most common etiologic fungi. Thirteen cases (56%) occurred within 3 months of HT, with a 3-month incidence of 3.8% (95% CI 2.2 to 6.4). Delayed chest closure (HR 3.3, 95% CI 1.4 to 7.6, p = 0.01) and the addition of OKT3, anti-thymocyte globulin or daclizumab to standard corticosteroid induction therapy (HR 2.7, 95% CI 1.1 to 6.2, p = 0.02) were independently associated with an increased risk of IFD. CONCLUSIONS: IFD incidence was greatest within the first 3 months post-HT, largely reflecting early surgical-site and nosocomial Candida and Aspergillus infections. Patients receiving additional induction immunosuppression or delayed chest closure were at increased risk for IFD. Peri-transplant anti-fungal prophylaxis should be considered in this subset of HT recipients.
Authors: Susan Stewart; Gayle L Winters; Michael C Fishbein; Henry D Tazelaar; Jon Kobashigawa; Jacki Abrams; Claus B Andersen; Annalisa Angelini; Gerald J Berry; Margaret M Burke; Anthony J Demetris; Elizabeth Hammond; Silviu Itescu; Charles C Marboe; Bruce McManus; Elaine F Reed; Nancy L Reinsmoen; E Rene Rodriguez; Alan G Rose; Marlene Rose; Nicole Suciu-Focia; Adriana Zeevi; Margaret E Billingham Journal: J Heart Lung Transplant Date: 2005-06-20 Impact factor: 10.247
Authors: Peter G Pappas; Barbara D Alexander; David R Andes; Susan Hadley; Carol A Kauffman; Alison Freifeld; Elias J Anaissie; Lisa M Brumble; Loreen Herwaldt; James Ito; Dimitrios P Kontoyiannis; G Marshall Lyon; Kieren A Marr; Vicki A Morrison; Benjamin J Park; Thomas F Patterson; Trish M Perl; Robert A Oster; Mindy G Schuster; Randall Walker; Thomas J Walsh; Kathleen A Wannemuehler; Tom M Chiller Journal: Clin Infect Dis Date: 2010-04-15 Impact factor: 9.079
Authors: L Rosow; J X Jiang; T Deuel; M Lechpammer; A A Zamani; D A Milner; R Folkerth; F M Marty; S Kesari Journal: Transpl Infect Dis Date: 2011-02-15 Impact factor: 2.228
Authors: J G Montoya; S V Chaparro; D Celis; J A Cortés; A N Leung; R C Robbins; D A Stevens Journal: Clin Infect Dis Date: 2003-10-01 Impact factor: 9.079
Authors: Gabriele Sganga; Minggui Wang; M Rita Capparella; Margaret Tawadrous; Jean L Yan; Jalal A Aram; Philippe Montravers Journal: Eur J Clin Microbiol Infect Dis Date: 2019-07-06 Impact factor: 3.267