Survival in the First Year of Heart Transplantation in a Center of a Developing Country, Infection versus Rejection as Causes of Mortality

Abstract

Despite advances in recent years in the surgical technique, immunosuppression and management of complications, infection continues to be a major cause of morbidity and mortality in heart transplantation. Taking into account the allocation of resources by health systems, habits and socio-economic status of patients in Latin America, it is assumed that there is a higher risk of infection in these countries, but the actual effect of the infection on post-transplant survival, and if adapted prophylaxis schemes for opportunistic microorganisms correspond to the reality of the patients. The objective of this study was to determine the survival in the first year of the patients sometimes heart transplant, evaluate the clinical and microbiological characteristics of the infections according to 3 periods of post-transplant follow-up, and compare the mortality associated with the infection versus rejection in a heart transplant center in Colombia. Observational, analytical, retrospective study in a center of IV level in Medellín, Colombia. They included 133 cardiac transplanted patients between 2012 and 2016, the average age was 47.7 years (SD +/- 12 years), 86% were men and 64.7% the cause of the transplant was idiopathic heart disease. The average ischemia time was 218 min (SD 58.22 min). During the first year, 60 infections were considered (45.11%, 60/133), during the first month 21.05%, 29.9% of the month 2-6 and 14.73% in the month 7-12. The majority of infections were 45% viral, 33% bacterial and 6.3% fungal. During the first year after transplant, 18 patients died (13%), due to 9% infection and rejection (4.51%). In a transplant center in Colombia that does not perform universal prophylaxis for CMV, viruses are the first cause of post-transplant infection. The rate of invasive fungal infection is very low. Infections are the leading cause of post-transplant death, doubling the risk associated with rejection, they must establish effective measures for their control.