Premium
Invasive fungal infection after heart transplantation: A 7‐year, single‐center experience
Author(s) -
Echenique Ignacio A.,
Angarone Michael P.,
Gordon Robert A.,
Rich Jonathan,
Anderson Allen S.,
McGee Edwin C.,
Abicht Travis O.,
Kang Joseph,
Stosor Valentina
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12650
Subject(s) - medicine , interquartile range , heart transplantation , cumulative incidence , hazard ratio , transplantation , odds ratio , incidence (geometry) , prospective cohort study , univariate analysis , confidence interval , immunology , multivariate analysis , physics , optics
Background Invasive fungal infections ( IFI s) are an infrequent but major complication of heart transplantation ( HT ). We sought to describe the epidemiology at our institution. Methods A prospective cohort study of 159 heart transplant recipients was performed from June 2005 to December 2012. IFI s were defined by European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Results By univariate analysis, Hispanic ethnicity was associated with IFI ( P =.01, odds ratio [ OR ] 7.0, 95% confidence interval [ CI ] 1.7‐27.9). Subsequently, a multivariate logistic regression was performed adjusting for Hispanic ethnicity, age, and gender. Seventeen IFI s were identified, occurring at a median 110 days post HT (interquartile range: 32‐411 days). Five IFI s (29% of IFI s and 3.1% of all HT ) occurred during the HT hospitalization, with 13 IFI s during the first year (incidence 8.2%). Conclusions The cumulative incidence was 10.7%. IFI s were associated with pre‐ and post‐ HT vancomycin‐resistant Enterococcus colonization and/or infection, post‐ HT renal replacement therapy, anti‐thymocyte globulin induction, and antibody‐mediated rejection. There were no associations with diabetes mellitus, desensitization, 2R/3R cellular rejection, treatments for rejection, re‐operation, neutropenia, or cytomegalovirus infection. IFI s were associated with death ( P =.02, OR 3.9, 95% CI 1.3‐12.1) and 1‐year mortality ( P <.001, OR 9.0, 95% CI 2.3‐35.7), but not 3‐year mortality. Associations with Hispanic ethnicity must be validated. Optimal strategies for risk reduction and prophylaxis remain undefined.