Clinical analysis on infections after cardiac transplantation.
10.4070/kcj.2001.31.8.815
- Author:
Jae Hyeong PARK
1
;
Yun Jung LEE
;
Soo Jin KANG
;
Jin Seock JANG
;
Meong Gun SONG
;
Yang Soo KIM
;
Cheol Whan LEE
;
Myeong Ki HONG
;
Jae Kwan SONG
;
Seong Wook PARK
;
Seung Jung PARK
;
Jae Joong KIM
Author Information
1. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Heart transplantation;
Infection
- MeSH:
Abscess;
Aerococcus;
Amphotericin B;
Anti-Bacterial Agents;
Aortitis;
Aspergillosis;
Cause of Death;
Chest Tubes;
Cytomegalovirus;
Empyema;
Female;
Fluconazole;
Follow-Up Studies;
Heart;
Heart Diseases;
Heart Failure;
Heart Transplantation*;
Humans;
Male;
Meningitis, Cryptococcal;
Mortality;
Pericardial Effusion;
Pneumonia;
Pneumonia, Bacterial;
Retinitis;
Sepsis;
Skin;
Transplantation;
Tuberculosis;
Tuberculosis, Miliary;
Tuberculosis, Pulmonary;
Viremia;
Wound Infection
- From:Korean Circulation Journal
2001;31(8):815-823
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: The heart transplantation is now accepted as a definite therapeutic modality in patients with terminal heart failure. With use of immunosuppressive agent, the incident of rejection deceased but risk of infection increased. Infection has been the most common cause of death in heart transplant patient, especially during the first year. The purpose of this study is to evaluate the infection of 91 patients who had heart transplantation at our hospital. METHODS: Of the total 91 patients, there were 75 males and 16 females, and the mean age was 39.8+/-14.1 years ranged from 14 to 62 years. All patients were in NYHA functional class III or IV preoperatively. The most common underlying heart diseases were dilated cardiomyopathy(72/91). The mean follow-up duration was 36.4 months (range; 0.6 ~ 103 months) and 10 patients died during this period. RESULT: There were 35 patients with infections (early infections in 4 and late infections in 32). The most common infection was skin infection of herpes virus (15 cases). Pneumonia occurred in 8 patients and responded well to antibiotics. But multiple empyema developed in one patient with bacterial pneumonia despite of antibiotics, chest tube insertion was needed. There were 4 patients with tuberculosis, 2 with tuberculous pericardial effusion, 1 with pulmonary tuberculosis and 1 with miliary tuberculosis. Sepsis was noted in 3 patients, 2 with bacterial sepsis and 1 with candidial sepsis. They all died despite of antibiotic treatment. There were 2 cases with wound infections and 1 with perianal abscess, and 1 with aortitis with paraaortic abscess due to Aerococcus viridans. Two patients with cryptococcal meningitis were successfully treated with liposomal amphotericin B and oral fluconazole, one of them also had invasive aspergillosis. There were 6 cases with cytomegalovirus (CMV) disease. Three of them had CMV viremia , 2 had CMV disease ( retinitis and colitis) and 1 had viremia and disease. CONCLUSION: There were 35 patients (38.5%) with infections and among then, 21 patients (23%) had one or more episodes of major infection. Infection was a major cause of death (30%) after heart transplantation. Careful control of infection is vital in the care of transplant recipients because infections result in increased morbidity and mortality.
