Infectious complications after heart transplantation in patients screened with gene expression profiling

Yasbanoo Moayedi, Carlos A. Gomez, Chun Po S. Fan, Robert J.H. Miller, Paul E. Bunce, Maxime Tremblay-Gravel, Farid Foroutan, Cedric Manlhiot, James Yee, Michael A. Shullo, Kiran K. Khush, Heather J. Ross, Jose G. Montoya, Jeffrey J. Teuteberg

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The risk of infection after heart transplantation is highest within the first year and represents the leading cause of early mortality. In this cohort of patients enrolled in the Outcomes AlloMap Registry (OAR), we sought to describe infection episodes (IEp) resulting in hospitalization, in the early (<1 year) and late (≥1 year) post-transplant period and determine the impact of immunosuppression on incidence of infection. METHODS: The primary aim was to assess the incidence and nature of IEp. The secondary aim was to evaluate the effect of potential risk factors, such as recipient age; sex; body mass index; panel-reactive antibodies; cytomegalovirus (CMV) primary mismatch; prednisone, tacrolimus, and sirolimus levels; and gene expression profile (GEP) score, in the development of IEp. RESULTS: The OAR comprises 1,504 patients, of whom 220 patients (14.6%) had an IEp during a median follow-up period of 382 days (interquartile range [IQR] 230 to 579 days). The cause-specific 5-year hazard ratio for any infection was 2.029 (p = 0.12). The pattern of early infection was consistent with nosocomial and opportunistic causes, whereas later infection was consistent with late-onset opportunistic and community-acquired etiologies. Sixty-two percent of the infections occurred early. In the time-dependent analysis, higher prednisone dose (log prednisone, hazard ratio [HR] 1.30, p = 0.022) was the most significant risk factor for all IEp. CONCLUSIONS: In the OAR cohort, the majority of infections occurred within 1 year after transplantation. Clinicians may consider more aggressive prednisone withdrawal in low-risk patients to reduce IEp.

Original languageEnglish (US)
Pages (from-to)611-618
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume38
Issue number6
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Keywords

  • AlloMap
  • cytomegalovirus
  • heart transplantation
  • immunosuppression
  • infectious episode
  • survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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  • Cite this

    Moayedi, Y., Gomez, C. A., Fan, C. P. S., Miller, R. J. H., Bunce, P. E., Tremblay-Gravel, M., Foroutan, F., Manlhiot, C., Yee, J., Shullo, M. A., Khush, K. K., Ross, H. J., Montoya, J. G., & Teuteberg, J. J. (2019). Infectious complications after heart transplantation in patients screened with gene expression profiling. Journal of Heart and Lung Transplantation, 38(6), 611-618. https://doi.org/10.1016/j.healun.2019.01.006