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Thorac Cardiovasc Surg 2015; 63(08): 675-683
DOI: 10.1055/s-0035-1564449
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Safety and Feasibility of Induction Immunosuppression When Driveline Infection Is an Indication for Cardiac Transplantation

Nirmanmoh Bhatia
1   Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Anthony J. Voelkel
2   Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, United States
,
Zeeshan Hussain
3   Department of Internal Medicine, University of Louisville, Louisville, Kentucky, United States
,
Umesh C. Sharma
4   Division of Cardiovascular Medicine, University of Buffalo, Buffalo, New York, United States
,
Mark S. Slaughter
5   Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, United States
,
Emma J. Birks
6   Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States
,
Kelly C. McCants
6   Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States
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Publikationsverlauf

06. Mai 2015

23. Juli 2015

Publikationsdatum:
14. September 2015 (online)

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Abstract

Background There is a paucity of data on the use of induction immunosuppression in patients with active infections undergoing orthotopic heart transplantation (OHT). We hypothesized that induction immunosuppression in patients with ventricular assist device (VAD) undergoing OHT with localized active driveline infection (DLI) does not lead to worse outcomes.

Materials and Methods We retrospectively analyzed our database for bridge-to-transplant VAD patients who underwent OHT and received induction therapy. Patients were stratified into those with and without active DLI at the time of OHT and followed up till death or at least 30 months after OHT. Posttransplant length of stay (LOS), frequency of infections, and mortality were compared between the two groups.

Results Thirty-eight patients (30 males) with mean age of 57.5 ± 13 years with VAD underwent OHT during the study period. Twelve had active DLI. Mean follow-up was 46.4 ± 23.1 months. In the DLI versus non-DLI group, there was no difference in mortality (17 vs. 23%, p = NS), LOS (16.3 ± 5.4 vs. 17.2 ± 13.7, p = NS), postoperative renal function, incidence of hyperacute or late rejection or infection either in the first month (25 vs. 23%, p = NS) or during entire follow-up (92 vs. 88%, p = NS). No patient in the DLI group had infections attributable to the same organism responsible for pretransplant DLI.

Conclusion In patients with active DLI, induction immunosuppression after OHT did not increase LOS, infections, or mortality after at least 30 months of follow-up and therefore it appears to be a safe and feasible therapeutic option.

Keywords

induction immunosuppression - driveline infection - orthotopic heart transplantation

Note

This study was presented as a poster in American College of Cardiology Scientific Sessions 2014, Washington D.C.[34]


 

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