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In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome. Surg Infect (Larchmt) 2020; 21:179-191. [DOI: 10.1089/sur.2019.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Fernández‐Ugidos P, Barge‐Caballero E, Gómez‐López R, Paniagua‐Martin MJ, Barge‐Caballero G, Couto‐Mallón D, Solla‐Buceta M, Iglesias‐Gil C, Aller‐Fernández V, González‐Barbeito M, Vázquez‐ Rodríguez JM, Crespo‐Leiro MG. In‐hospital postoperative infection after heart transplantation: Risk factors and development of a novel predictive score. Transpl Infect Dis 2019; 21:e13104. [DOI: 10.1111/tid.13104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/21/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Affiliation(s)
| | - Eduardo Barge‐Caballero
- Unidad de Insuficiencia Cardiaca y Trasplante cardiaco, Servicio Cardiología Complexo Hospitalario Universitario A Coruña (CHUAC) INIBIC UDC A Coruña Spain
- Centro de Investigación Biomédica en Red de enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
| | | | - María J. Paniagua‐Martin
- Unidad de Insuficiencia Cardiaca y Trasplante cardiaco, Servicio Cardiología Complexo Hospitalario Universitario A Coruña (CHUAC) INIBIC UDC A Coruña Spain
- Centro de Investigación Biomédica en Red de enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
| | - Gonzalo Barge‐Caballero
- Unidad de Insuficiencia Cardiaca y Trasplante cardiaco, Servicio Cardiología Complexo Hospitalario Universitario A Coruña (CHUAC) INIBIC UDC A Coruña Spain
- Centro de Investigación Biomédica en Red de enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
| | - David Couto‐Mallón
- Unidad de Insuficiencia Cardiaca y Trasplante cardiaco, Servicio Cardiología Complexo Hospitalario Universitario A Coruña (CHUAC) INIBIC UDC A Coruña Spain
- Centro de Investigación Biomédica en Red de enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
| | | | | | | | | | - Jose Manuel Vázquez‐ Rodríguez
- Unidad de Insuficiencia Cardiaca y Trasplante cardiaco, Servicio Cardiología Complexo Hospitalario Universitario A Coruña (CHUAC) INIBIC UDC A Coruña Spain
- Centro de Investigación Biomédica en Red de enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
| | - María G. Crespo‐Leiro
- Unidad de Insuficiencia Cardiaca y Trasplante cardiaco, Servicio Cardiología Complexo Hospitalario Universitario A Coruña (CHUAC) INIBIC UDC A Coruña Spain
- Centro de Investigación Biomédica en Red de enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
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Infections in Heart, Lung, and Heart-Lung Transplantation. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7121494 DOI: 10.1007/978-1-4939-9034-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Half a century has passed since the first orthotopic heart transplant took place. Surgical innovations allowed for heart, lung, and heart-lung transplantation to save lives of patients with incurable chronic cardiopulmonary conditions. The complexity of the surgical interventions, chronic host health conditions, and antirejection immunosuppressive medications makes infectious complications common. Infections have remained one of the main barriers for successful transplantation and a source of significant morbidity and mortality. Recognition of infections and its management in this setting require outstanding clinical skills since transplant recipients may not exhibit classic signs or symptoms of disease, and laboratory work has some pitfalls. The prevention, identification, and management of infectious diseases complications in this population are a priority to undertake to improve the medical outcomes of transplantation. Herein, we reviewed the historical aspects, epidemiology, and prophylaxis of infections in heart, lung, and heart-lung transplantation. We also discuss the most prevalent organisms affecting the host and the organ systems involved.
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Sanches BF, Morgado J, Carvalho N, Anjos R. Multiple parasitic infections in a cardiac transplant recipient. BMJ Case Rep 2015; 2015:bcr-2014-207033. [PMID: 26109619 DOI: 10.1136/bcr-2014-207033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infectious complications represent an important cause of morbidity and death in patients with transplant. Parasitic infections are less frequent than viral and bacterial agents, and are often overlooked. We describe the case of a 13-year-old adolescent, born in São Tomé Island, who was under immunosuppressive therapy after a cardiac transplant. The patient had an intermittent course of diarrhoea, abdominal pain and vomiting. She was admitted dehydrated, and Strongyloides stercoralis, Schistosoma intercalatum and Cystoisospora belli were isolated in her stools. The patient was treated with ivermectin, albendazole, praziquantel and ciprofloxacin with clinical and microbiological resolution. Her immunosuppressive therapy was reduced during hospitalisation. We believe that the parasitic infection was a result of a recrudescence of dormant infections acquired in her homeland. To the best of our knowledge, there are no reports of cystoisosporiasis or schistosomiasis in heart transplant recipients.
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Affiliation(s)
| | - Joana Morgado
- Department of Pediatrics, Hospital Espírito Santo, Évora, Portugal
| | - Nuno Carvalho
- Department of Pediatric Cardiology, Hospital Santa Cruz, Lisbon, Portugal
| | - Rui Anjos
- Department of Pediatric Cardiology, Hospital Santa Cruz, Lisbon, Portugal
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Pazdernik M, Malek I, Koudelkova E, Sochman J, Kautzner J. Bone marrow suppression and associated consequences in patients after heart transplantation: A 6-year retrospective review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:372-7. [PMID: 26000773 DOI: 10.5507/bp.2015.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/22/2015] [Indexed: 11/23/2022] Open
Abstract
AIMS To evaluate the incidence of bone marrow suppression and consequences of MMF dose adjustment in patients within the first year after heart transplantation. METHODS Group I (n=47) was treated with a regimen currently used in patients after heart transplantation (mycophenolatemofetil - MMF, valganciclovir - VGC and trimethoprim/sulfamethoxazole - TMP-SMX). Group II (n=47) received only MMF of potentially myelotoxic medications. The myelotoxic effect and need for dose modification were assessed. The incidence of rejections and infectious episodes associated with MMF adjustment were analyzed during the first 12 months in Group I. RESULTS There was a significantly greater proportion of patients with leukopenia (leukocyte count < 4 x 10^9/L) at 3 months after orthotopic heart transplantation in Group I compared with Group II (19.1% vs 2.1%; P = 0.02). The difference in lymphopenia (lymphocyte count < 0.8 x 10^9/L) at 3 months follow-up was highly significant (38.3 % vs 6.4 %; P = 0.0002). MMF was modified due to bone marrow suppression or severe infection in 63.8% patients in Group I and in only 8.5% of patients in Group II (P < 0.001). Reducing or stopping MMF was not associated with increased rejections. In Group I, at least 1 episode of higher degree cellular or humoral rejection occurred in 35% of patients with the standard MMF dosage compared with only 26% in patients with modified MMF (P = 0.0534). CONCLUSIONS Addition of VGC+TMP-SMX to current immunosuppressive medication regimen in patients after heart transplantation is associated with significant lymphocytopenia and leukopenia. Importantly, modification of immunosuppressive prophylaxis (reducing or stopping MMF) leads to normalization of blood count without increased incidence of rejections.
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Affiliation(s)
- Michal Pazdernik
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Ivan Malek
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Eva Koudelkova
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jan Sochman
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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Oliveira-Braga KA, Nepomuceno NA, Correia AT, Jatene FB, Pêgo-Fernandes PM. Effects of prednisone on mucociliary clearance in a murine model. Transplant Proc 2013; 44:2486-9. [PMID: 23026626 DOI: 10.1016/j.transproceed.2012.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
All transplant patients are at increased risk of developing pulmonary infections, a significant cause of morbidity and mortality. Immunosuppressants increase the incidence of lung infection by acting not only directly on the inflammatory cells, but also on the native immune system. Experimental studies have shown corticosteroid therapy, which is used in most immunosuppressive protocols after transplantation, to suppress mucus production by inhibiting calceiform. The objective of this study was to evaluate the effects of prednisone on mucociliary clearance. A total of 120 male Wistar rats were distributed into 4 groups. Animals in P1, P2, and P3 groups received daily doses of prednisone (0.625, 1.25, and 2.5 mg/kg/d), and hosts in the Sal group underwent gavage with saline solution (2.5 mL/d). After 7, 15, and 30 days, treatment, animals were killed. We assessed ciliary beating frequency (CBF), mucociliary transport velocity (MCTV), and mucus transportability (MT). There was no significant difference for CBF regarding dose (P = .089) or treatment duration (P = .175). MCTV values of 0.60 ± 0.14 in group P1, 0.59 ± 0.13 in group P2, 0.51 ± 0.19 in group P3, and 0.61 ± 0.08 Group Sal, showed P3 to significantly differ from P1 (P = .048) and Sal (P = .007) groups. Regardless of the prednisone dose, all groups displayed impaired MT compared with the Sal group: P1 (P = .02); P2 (P = .02) P3 (P = .03). There was no interaction between the therapy and the treatment time for CBF (P = .10), MCTV (P = .71), and MT (P = .64). Prednisone reduced the transportability of mucus even when administered at low doses; however, this change was not sufficient to alter the mucociliary clearance. Only high doses of prednisone impaired mucociliary clearance.
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Affiliation(s)
- K A Oliveira-Braga
- Laboratory of Thoracic Surgery Research, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Carbone J, Lanio N, Gallego A, Kern F, Navarro J, Muñoz P, Alonso R, Catalán P, Fernández-Yáñez J, Palomo J, Ruiz M, Fernández-Cruz E, Sarmiento E. Simultaneous Monitoring of Cytomegalovirus-Specific Antibody and T-cell levels in Seropositive Heart Transplant Recipients. J Clin Immunol 2012; 32:809-19. [DOI: 10.1007/s10875-012-9670-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
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Balandín B, Fernández I, Casares C, Suárez MD. [Disseminated cryptococcosis in a patient with a heart transplant]. Enferm Infecc Microbiol Clin 2012; 30:104-5. [PMID: 22209533 DOI: 10.1016/j.eimc.2011.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 11/17/2022]
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Sarmiento E, Lanio N, Gallego A, Rodriguez-Molina J, Navarro J, Fernandez-Yañez J, Palomo J, Rodríguez-Hernández C, Ruiz M, Alonso R, Fernandez-Cruz E, Carbone J. Immune monitoring of anti cytomegalovirus antibodies and risk of cytomegalovirus disease in heart transplantation. Int Immunopharmacol 2008; 9:649-52. [PMID: 18940269 DOI: 10.1016/j.intimp.2008.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
We sought to determine whether quantitative assessment of anti-cytomegalovirus (CMV) antibodies could be useful to identify patients at risk of cytomegalovirus (CMV) disease after heart transplantation (HT). 75 patients who underwent HT at a single health care center were prospectively studied. Induction therapy included 2 doses of daclizumab and maintenance tacrolimus (n=42) or cyclosporine (n=29), mycophenolate mofetil and prednisone. All patients received prophylaxis with gancyclovir or valganciclovir. Anti-CMV intravenous immunoglobulin (CMV-IG) was added in high risk patients (CMV D+/R- serostatus). Serial determinations of anti-CMV antibodies, immunoglobulins (IgG, IgA, IgM) and IgG-subclasses were analysed. CMV infection was based on detection of the virus by antigenemia. CMV disease consisted of detection of signs or symptoms attributable to this microorganism. Ten patients (13.3%) developed CMV disease. Mean time of development of CMV disease was 3.4+/-1.6 months. In Cox regression analysis, patients with low baseline anti-CMV titers (<4.26 natural logarithm of titer, RH: 8.1, 95%CI: 1.93-34.1, p=0.004) and recipients with 1-month post-HT IgG hypogammaglobulinemia (IgG<500 mg/dl, RH: 4.49, 95%CI: 1.26-15.94, p=0.02) were at higher risk of having CMV disease. Despite use of prophylactic CMV-IG, D+/R- patients showed significantly lower titers of anti-CMV antibodies at 7 d, 30 d and 90 d post HT as compared with HT recipients without infections. Four out of 6 of these patients developed late CMV disease. Monitoring of specific anti-CMV antibodies on the bedside warrants further evaluation as a potential tool to identify heart transplant recipients at higher risk of CMV disease.
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Affiliation(s)
- Elizabeth Sarmiento
- Transplant Immunology Group, Immunology Department, University Hospital Gregorio Marañon, Madrid, Spain.
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