Ventricular assist devices as bridge to heart transplantation: impact on post-transplant infections.
Ventricular assist devices as bridge to heart transplantation: impact on post-transplant infections.
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DOI：
10.1186/s12879-016-1658-0
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发表时间：
2016-07-08
影响因子：
3.7
通讯作者：
Swiss Transplant Cohort Study (STCS)
中科院分区：
文献类型：
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作者：
Héquet D;Kralidis G;Carrel T;Cusini A;Garzoni C;Hullin R;Meylan PR;Mohacsi P;Mueller NJ;Ruschitzka F;Tozzi P;van Delden C;Weisser M;Wilhelm MJ;Pascual M;Manuel O;Swiss Transplant Cohort Study (STCS)
对于等待心脏移植的心力衰竭患者来说，心室辅助装置（VAD）是很有价值的选择。我们在全国心脏移植受者队列中评估了移植前 VAD 植入对移植后感染发生率的影响。对 2008 年 5 月至 2012 年 12 月期间纳入瑞士移植队列研究的心脏移植受者进行了分析。累积发生率曲线用于计算移植后细菌或念珠菌感染（主要终点）和其他感染（次要终点）的发生率。使用将死亡视为竞争风险的 Cox 回归模型来确定移植后发生感染的危险因素。总体而言，该研究纳入了 119 名患者，其中 35 名患者接受了 VAD，84 名患者未接受 VAD。 VAD 患者移植后细菌或念珠菌感染的累积发生率为 37.7%，非 VAD 患者为 40.4%。在多变量分析中，使用复方新诺明预防是与移植后细菌/念珠菌感染相关的唯一变量（HR 0.29 [95 % CI 0.15-0.57]，p< 0.001），但 VAD 的存在则不是（HR 0.94，[95 % CI 0.38-2.32]， p = 0.89，对于连续流设备，HR 0.45 [0.15 – 1.34]，p = 0.15，对于其他设备）。 VAD 患者的移植后病毒和所有真菌感染的风险并未增加。 VAD 组的一年生存率为 82.9% (29/35)，非 VAD 组的一年生存率为 82.1% (69/84)。 VAD组移植后死亡的6例患者均有移植前VAD感染史。在这个全国范围的心脏移植受者队列中，移植时 VAD 的存在对移植后感染的发展没有影响。本文的在线版本 (doi:10.1186/s12879-016-1658-0) 包含补充材料，可供授权用户使用。
Ventricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac transplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant infections in a nationwide cohort of heart transplant recipients. Heart transplant recipients included in the Swiss Transplant Cohort Study between May 2008 and December 2012 were analyzed. Cumulative incidence curves were used to calculate the incidence of bacterial or Candida infections (primary endpoint) and of other infections (secondary endpoint) after transplant. Cox regression models treating death as a competing risk were used to identify risk factors for the development of infection after transplant. Overall, 119 patients were included in the study, 35 with a VAD and 84 without VAD. Cumulative incidences of post-transplant bacterial or Candida infections were 37.7 % in VAD patients and 40.4 % in non-VAD patients. In multivariate analysis, the use of cotrimoxazole prophylaxis was the only variable associated with bacterial/Candida infections after transplant (HR 0.29 [95 % CI 0.15-0.57], p < 0.001), but presence of a VAD was not (HR 0.94, [95 % CI 0.38-2.32], p = 0.89, for continuous-flow devices, and HR 0.45 [0.15 – 1.34], p = 0.15, for other devices). Risk for post-transplant viral and all fungal infections was not increased in patients with VAD. One-year survival was 82.9 % (29/35) in the VAD group and 82.1 % (69/84) in the non-VAD group. All 6 patients in the VAD group that died after transplant had a history of pre-transplant VAD infection. In this nationwide cohort of heart transplant recipients, the presence of VAD at the time of transplant had no influence on the development of post-transplant infections. The online version of this article (doi:10.1186/s12879-016-1658-0) contains supplementary material, which is available to authorized users.