Epidemiology of Infections in Adult Heart and Lung Transplant Recipients: A Single Center Experience

Abstract

<h3>Purpose</h3> Infectious complications are a common cause of morbidity and mortality among solid organ transplant (SOT) recipients. Understanding their epidemiology and outcomes is vital when planning preventative strategies. <h3>Methods</h3> We conducted a retrospective study of selected infections diagnosed in patients receiving heart (HT) or lung transplantation (LT) from January 2013 to June 2018. We examined the incidence of infections and outcomes one-year post-transplant. <h3>Results</h3> We reviewed 217 patients that underwent heart or lung transplantation (109 HT, 108 LT) at our center over a five-year period. Median follow-up was 2.5 years, median age was 51, 68% were males, and 75%-white. Indication for transplant in HT recipients was predominantly idiopathic dilated cardiomyopathy (22%) and ischemic dilated cardiomyopathy (11%). Indications for lung transplants included idiopathic pulmonary fibrosis (19%), chronic obstructive pulmonary disease (9%), and cystic fibrosis (7%). Within the first year post-transplant, 46% of transplant recipients had defined infections (56% LT, 35% HT)(Table). In the HT group, CMV (14%) respiratory viruses (9%), aspergillosis (6%), and <i>Clostridioides difficile</i> infection (6%) were most common. In the LT group, respiratory viruses (39%), aspergillosis (21%), <i>Clostridioides difficile</i> (14%), and extended-spectrum beta-lactamase producing bacteria (9%) were most common. All-cause mortality at one year was 5% and 10% in the HT and LT recipients, respectively. There was no infection-related mortality at one year in both groups. <h3>Conclusion</h3> Despite standard infection prevention strategies, nearly half of all HT and LT recipients had identified infections at the end of one year. The most frequent infectious process was respiratory viral infections, particularly in the LT group. Further studies identifying associated risk factors and additional preventative measures may be needed to reduce these infections.