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Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation.

ABSTRACT: BACKGROUND:Infectious complications are a major cause of morbidity and mortality after heart transplantation (HT). However, the epidemiology and outcomes of these infections in the recent population of adult heart transplant recipients have not been investigated. METHODS:We conducted a single-center retrospective study on infectious complications occurring within 180 days following HT on consecutive heart transplant recipients, from January 2011 to June 2015 at Bichat University Hospital in Paris, France. Risk factors for non-viral infections occurring within 8, 30 and 180 days after HT were investigated using competing risk analysis. RESULTS:Overall, 113 patients were included. Fifty-eight (51%) HTs were high-priority allocations. Twenty-eight (25%) patients had an extracorporeal membrane oxygenation (ECMO) support at the time of transplantation. Ninety-two (81%) patients developed at least one infection within 180 days after HT. Bacterial and fungal infections (n?=?181 episodes) occurred in 80 (71%) patients. The most common bacterial and fungal infections were pneumonia (n?=?95/181 episodes, 52%), followed by skin and soft tissue infections (n?=?26/181, 14%). Multi-drug-resistant bacteria were responsible for infections in 21 (19%) patients. Viral infections were diagnosed in 44 (34%) patients, mostly Cytomegalovirus infection (n?=?39, 34%). In multivariate subdistribution hazard model, prior cardiac surgery (subdistribution hazard ratio sHR?=?2.7 [95% CI 1.5-4.6] p?

SUBMITTER: Pons S

PROVIDER: S-EPMC6347647 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation.

Pons Stéphanie S Sonneville Romain R Bouadma Lila L Styfalova Lenka L Ruckly Stéphane S Neuville Mathilde M Radjou Aguila A Lebut Jordane J Dilly Marie-Pierre MP Mourvillier Bruno B Dorent Richard R Nataf Patrick P Wolff Michel M Timsit Jean-François JF

Annals of intensive care 20190125 1

<h4>Background</h4>Infectious complications are a major cause of morbidity and mortality after heart transplantation (HT). However, the epidemiology and outcomes of these infections in the recent population of adult heart transplant recipients have not been investigated.<h4>Methods</h4>We conducted a single-center retrospective study on infectious complications occurring within 180 days following HT on consecutive heart transplant recipients, from January 2011 to June 2015 at Bichat University H ...[more]

PMID: 30684052

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Project description:Extracorporeal membrane oxygenation is a potentially life-saving intervention in refractory cardiopulmonary failure, but it requires anticoagulation to prevent circuit thromboses, which exposes the patient to hemorrhagic complications. Heparin has traditionally been the anticoagulant of choice, but the direct thrombin inhibitor bivalirudin is routinely used in cases of heparin-induced thrombocytopenia and has been suggested as a superior choice. We sought to examine the timing of hemorrhagic and thrombotic complications after extracorporeal membrane oxygenation cannulation and to compare the rates of such complications between patients anticoagulated with heparin versus bivalirudin.DesignRetrospective cohort study.SettingJohns Hopkins Hospital patients between January 2016 and July 2019.PatientsAdult (> 18 yr) extracorporeal membrane oxygenation patients.InterventionsPatients were anticoagulated either with heparin or bivalirudin.Measurements and main resultsWe compared rates of hemorrhagic and thrombotic complications by time on heparin versus bivalirudin and characterized the average time to each complication. Of 144 extracorporeal membrane oxygenation patients (mean age 55.3 yr; 58% male), 41% were on central venoarterial extracorporeal membrane oxygenation, 40% on peripheral venoarterial extracorporeal membrane oxygenation, and 19% on venovenous extracorporeal membrane oxygenation. Thirteen patients (9%) received bivalirudin during their extracorporeal membrane oxygenation run, due to concern for (n = 8) or diagnosis of (n = 4) heparin-induced thrombocytopenia or for heparin resistance (n = 1). The rate of hemorrhagic or thrombotic complications did not differ between heparin (0.13/d) and bivalirudin (0.06/d; p = 0.633), but patients on bivalirudin received significantly fewer blood transfusions (1.0 U of RBCs/d vs 2.9/d on heparin; p < 0.001).ConclusionsOur results confirm the safety and efficacy of bivalirudin as an alternative anticoagulant in extracorporeal membrane oxygenation and suggest a potential benefit in less blood product transfusion, although prospective studies are needed to evaluate the true effect of bivalirudin versus the disease processes that prompted its use in our study population.

Dataset Information

Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation.

Publications

Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation.

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