Clinical Features and Outcome of Infectious Complications in Heart Transplant Recipients in Korea

Mi Kyong Joung; Cheol-In Kang; Jeong-a Lee; Sooyoun Moon; Doo Ryeon Chung; Jae-Hoon Song; Eun-Seok Jeon; Pyo-Won Park; Kyong Ran Peck

doi:10.3947/ic.2010.42.6.375

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Joung, Kang, Lee, Moon, Chung, Song, Jeon, Park, and Peck: Clinical Features and Outcome of Infectious Complications in Heart Transplant Recipients in Korea

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(6): 375-382.

Published online: 31 December 2010

DOI: https://doi.org/10.3947/ic.2010.42.6.375

Clinical Features and Outcome of Infectious Complications in Heart Transplant Recipients in Korea

Mi Kyong Joung¹, Cheol-In Kang¹, Jeong-a Lee¹, Sooyoun Moon¹, Doo Ryeon Chung¹, Jae-Hoon Song¹, Eun-Seok Jeon², Pyo-Won Park³, Kyong Ran Peck¹

¹Division of Infectious Diseases, Sungkyunkwan University, School of Medicine, Seoul, Korea.

²Division of Cardiology, Sungkyunkwan University, School of Medicine, Seoul, Korea.

³Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University, School of Medicine, Seoul, Korea.

Correspondence to Kyong Ran Peck, MD. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-0329, Fax: +82-2-3410-0041, krpeck@skku.edu

Received 18 December 2009 Revised 11 November 2010 Accepted 22 November 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Although heart transplantation is the only therapeutic modality for patients with end-stage heart disease, immunosuppressive therapy to reduce organ rejection may increase the risk of infection in transplant patients. Little is known regarding infectious complications in heart transplant recipients in Korea. Thus, this study was performed to evaluate the clinical features and outcome of infectious complications in patients receiving heart transplantation.

Materials and Methods

A retrospective cohort study was performed by reviewing medical records of patients who underwent heart transplantation from December 1996 to October 2008 in Samsung Medical Center, Seoul, Korea.

Results

A total of 72 cardiac allograft recipients were included in the analysis. Median follow-up duration was 417 (range, 2-3995) days. During the follow-up period, 75 infectious complications occurred in 39 (54.2%) recipients, of which 31 cases (41.3%) were caused by bacteria, 28 (37.3%) by viruses, 10 (13.3%) by fungi, 4 (5.4%) by Pneumocystis jirovecii, and 2 (2.7%) by Mycobacterium tuberculosis. Median onset time of bacterial, viral and fungal infection were 153, 106 and 68 days, respectively. The most common site of infection was lung (n=26, 34.7%), followed by gastrointestinal tract (n=11, 14.7%) and oral cavity (n=9, 12%). All patients were sero-positive for cytomegalovirus (CMV)-specific IgG before transplantation and received preemptive therapy of CMV infection. After heart transplantation, 44 (63.8%) patients experienced CMV reactivation identified by CMV antigenemia and 9 (13%) patients had organ-specific CMV diseases. The overall mortality rate was 33.3% (24/72). Infectious complications were the most common cause of death (n=10, 41.7%). The operative risk factors for death were lung infection, fungal infection and bloodstream infection.

Conclusions

In the current study, the lung was the most common site of infection and bacteria were the most frequent etiologic pathogens among heart transplant recipients. Infectious complications, especially fungal infections were the most common causes of death. Prevention strategies against fungal infections should be evaluated in the future studies.

Keywords: Heart transplantation, Infectious complication, Lung

Figures and Tables

Table 1

Demographic Characteristics of Study Population

BMI, Body mass index; ECMO, Extracorporeal membrane oxygenation; IABP, Intra-aortic balloon pump.

Table 2

Infection Sites and Cause of Deaths among 72 Heart Transplant Recipients

^aothers : Urinary tract infections, herpes keratoconjuctivitis, cytomegalovirus retinitis, herpes zoster

Table 3

Incidence of Infectious Causative Pathogens among 72 Heart Transplant Recipients

^aCMV disease

CMV, cytomegalovirus; HSV, herpes simplex virus; VZV, varicella zoster virus.

Table 4

Risk Factors Associated with Death in Patients Undergone Heart Transplantation

^a From 1998 to 2000

ECMO, Extracorporeal membrane oxygenation; CCS, Charlson comorbidity score; CRRT, Continous renal replacement therapy.

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