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

Nirmanmoh Bhatia, Anthony J. Voelkel, Zeeshan Hussain, Umesh C. Sharma, Mark S. Slaughter, Emma J. Birks, Kelly C. McCants

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish
Pages (from-to)675-683
Number of pages9
JournalThoracic and Cardiovascular Surgeon
Volume63
Issue number8
DOIs
StatePublished - Sep 14 2015

Bibliographical note

Publisher Copyright:
© 2015 Georg Thieme Verlag KG.

Keywords

  • driveline infection
  • induction immunosuppression
  • orthotopic heart transplantation

ASJC Scopus subject areas

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

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