Abstract
BackgroundVentricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac transplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant infections in a nationwide cohort of heart transplant recipients.MethodsHeart transplant recipients included in the Swiss Transplant Cohort Study between May 2008 and December 2012 were analyzed. Cumulative incidence curves were used to calculate the incidence of bacterial or Candida infections (primary endpoint) and of other infections (secondary endpoint) after transplant. Cox regression models treating death as a competing risk were used to identify risk factors for the development of infection after transplant.ResultsOverall, 119 patients were included in the study, 35 with a VAD and 84 without VAD. Cumulative incidences of post-transplant bacterial or Candida infections were 37.7 % in VAD patients and 40.4 % in non-VAD patients. In multivariate analysis, the use of cotrimoxazole prophylaxis was the only variable associated with bacterial/Candida infections after transplant (HR 0.29 [95 % CI 0.15-0.57], p < 0.001), but presence of a VAD was not (HR 0.94, [95 % CI 0.38-2.32], p = 0.89, for continuous-flow devices, and HR 0.45 [0.15 – 1.34], p = 0.15, for other devices). Risk for post-transplant viral and all fungal infections was not increased in patients with VAD. One-year survival was 82.9 % (29/35) in the VAD group and 82.1 % (69/84) in the non-VAD group. All 6 patients in the VAD group that died after transplant had a history of pre-transplant VAD infection.ConclusionIn this nationwide cohort of heart transplant recipients, the presence of VAD at the time of transplant had no influence on the development of post-transplant infections.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1658-0) contains supplementary material, which is available to authorized users.
Highlights
Ventricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac transplantation
Ventricular assist devices (VAD) are an established option for patients suffering from end-stage heart failure that may not survive until a suitable donor comes [1]
While some studies reported that pre-transplant VADrelated infections correlated with a higher incidence of bacteremia following transplantation and a decreased survival [12, 13], in another study the presence of VAD increased the risk for local, but not for disseminated infections, and VAD infections were not associated with inferior outcomes [14]
Summary
Ventricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac transplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant infections in a nationwide cohort of heart transplant recipients. Ventricular assist devices (VAD) are an established option for patients suffering from end-stage heart failure that may not survive until a suitable donor comes [1]. Large registries of patients have shown that mortality after heart transplantation is not increased in patients with VAD support, when continuous-flow left ventricular devices are used [10, 11]. Data on the impact of VAD implantation on the incidence of Héquet et al BMC Infectious Diseases (2016) 16:321 post-transplant infections are conflicting, in particular when the device is infected at the time of transplantation. Despite some reports suggesting that VAD may generate a relative state of immunosuppression after implantation [15, 16], there is a lack of current data reporting on the incidence of opportunistic viral or fungal infection in heart transplant recipients with pre-transplant VAD
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