Infections in heart transplant recipients.

Abstract

Heart transplantation is an increasingly common and successful mode of treatment for advanced cardiomyopathy, coronary artery disease, and congestive heart failure. Cumulative figures as of October 1990 revealed that 14,000 heart transplantations and 1,100 heart-lung or lung transplantations had been performed worldwide, with further increases in annual numbers limited only by the availability of donors. Approximately 90% of heart transplant recipients survive for 30 days, with a 10-year actuarial survival rate of 70%. These figures are most impressive in light of the condition of the patients before they receive a transplant: most are categorized as New York Heart Association Class IV, with estimated life expectancies of 30-60 days without transplantation. The use of heart transplantation for infants <12 months of age is a new development, with an actuarial survival rate of 80% at 5 years. Improvements in methods of immunosuppression and of therapy for infection in immunosuppressed patients have decreased mortality due to infection in heart transplant recipients. Still, at least one-fourth of deaths among these patients are due to infection. Short-term mortality among heart transplant recipients is due mostly to infection and acute rejection; most long-term mortality is due to transplant atherosclerosis. The heart transplant recipient is at greatest risk for life-threatening infection in the first 3 months after transplantation, with a major infectious episode occurring in onethird of patients by 12 months. Infections rarely develop after this period. Any discussion of infections following heart transplantation must include the preoperative screening of the recipient and the donor for infectious risks, the use of perioperative and prophylactic antibiotics, the impact of various immunosuppressive regimens on early and late infectious complications, and the differing etiologic agents and sites of early and late infections.