1528. The Impact of Infection Among Ventricular Assist Device Recipients on Post-Transplant Outcomes:  A Multicenter Retrospective Review
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: The consequence of ventricular assist device (VAD)-associated infections (VAI) on post-transplant outcome is not well understood.  Our study evaluates the effect of VAI and non-VAD associated infections (NVAI) among patients bridged to heart transplant.  We describe the clinical characteristics and outcomes of this population.

Methods: We retrospectively reviewed the medical records of 74 consecutive patients who underwent VAD placement and subsequent heart transplant from January 2007 to December 2012 at Montefiore Medical Center and Hospital of the University of Pennsylvania.  We used International Society for Heart and Lung Transplantation definitions to determine VAI and NVAI.  The term VAI encompasses VAD-related (VRI) and VAD-specific infections (VSI).  We identified the incidence of infection and its impact on episodes of rejection and mortality using standard statistical analyses. 

Results: Twenty-three (31.1 %) patients had VAI.  Nine patients had a VRI (12.1%) and 18 had a VSI (24.3%).  Forty-six (62.2%) patients had a NVAI, 13 (17.6%)  of which had pneumonia and 12 (16.2%) had a urinary tract infection (UTI).  Patients with a VAI and those without VAI had a similar probability of survival at one-year.  Other outcomes are listed (see Table 1).  There was no significant correlation between mortality rate and VAI, VRI, VSI, NVAI, DM, gender, or age.  However, NVAIs pre-transplantation, specifically UTI (p=0.024) and pneumonia (p=0.001), were associated with rejection (p=0.008, see Table 2).   

Table 1

 

Patients with VAI

(N = 23)

Patients without VAI

(N = 51)

P value

Age (years)

46.1

50.8

0.178

Diabetes

12 (40%)

18 (60%)

0.171

Rejection

15 (65.2%)

31 (60.8%)

0.799

Death at 1 year

3 (13.0%)

5 (9.8%)

0.698

Likelihood of survival at 1 year

64.2%-98.0%

71.3%-98.2%

 

Table 2

 

Rejection

(N = 46)

No Rejection

(N = 28)

P value

NVAI

34 (73.9%)

12 (42.9%)

0.008

a)Pneumonia

13 (28.3%)

0 (0%)

0.001

      b)UTI

11 (23.9%)

1 (3.6%)

0.024

Conclusion: VAIs did not affect all-cause mortality post-transplantation.  However NVAIs, specifically UTI and pneumonia, were associated with the development of rejection after transplantation.  Larger studies should be conducted to further evaluate the effect of VAI on rejection and overall outcomes in patients with VAD prior to transplantation.

Doreen Lee, MD1, Dana Levy, MD1, Keith Hamilton, MD2, Victoria Muggia, MD1, Yoram Puius, MD, PhD1, Jonathan Shuter, MD1, Kristen Zeitler, PharmD2, Tamara Claridge, PharmD, BCPS2, Jaime Gray, PharmD, BCPS2 and Grace Minamoto, MD1, (1)Montefiore Medical Center, Bronx, NY, (2)Hospital of the University of Pennsylvania, Philadelphia, PA

Disclosures:

D. Lee, None

D. Levy, None

K. Hamilton, None

V. Muggia, None

Y. Puius, None

J. Shuter, None

K. Zeitler, None

T. Claridge, None

J. Gray, None

G. Minamoto, None

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