PMID- 30704838 OWN - NLM STAT- MEDLINE DCOM- 20201110 LR - 20201110 IS - 1557-3117 (Electronic) IS - 1053-2498 (Linking) VI - 38 IP - 6 DP - 2019 Jun TI - Infectious complications after heart transplantation in patients screened with gene expression profiling. PG - 611-618 LID - S1053-2498(19)30006-3 [pii] LID - 10.1016/j.healun.2019.01.006 [doi] AB - 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. CI - Copyright (c) 2019 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. FAU - Moayedi, Yasbanoo AU - Moayedi Y AD - Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, Department of Medicine, Stanford University, Stanford, California, USA; Ted Rogers Centre of Excellence for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. FAU - Gomez, Carlos A AU - Gomez CA AD - Division of Infectious Disease, Department of Medicine, Stanford University, Stanford, California, USA. FAU - Fan, Chun Po S AU - Fan CPS AD - Ted Rogers Centre of Excellence for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. FAU - Miller, Robert J H AU - Miller RJH AD - Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, Department of Medicine, Stanford University, Stanford, California, USA. FAU - Bunce, Paul E AU - Bunce PE AD - Department of Medicine, Division of Infectious Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada. FAU - Tremblay-Gravel, Maxime AU - Tremblay-Gravel M AD - Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, Department of Medicine, Stanford University, Stanford, California, USA. FAU - Foroutan, Farid AU - Foroutan F AD - Ted Rogers Centre of Excellence for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. FAU - Manlhiot, Cedric AU - Manlhiot C AD - Ted Rogers Centre of Excellence for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. FAU - Yee, James AU - Yee J AD - CareDx, Inc., Brisbane, California, USA. FAU - Shullo, Michael A AU - Shullo MA AD - department of Medicine, West Virginia University, Morgantown, West Virginia, USA. FAU - Khush, Kiran K AU - Khush KK AD - Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, Department of Medicine, Stanford University, Stanford, California, USA. FAU - Ross, Heather J AU - Ross HJ AD - Ted Rogers Centre of Excellence for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. FAU - Montoya, Jose G AU - Montoya JG AD - Division of Infectious Disease, Department of Medicine, Stanford University, Stanford, California, USA. FAU - Teuteberg, Jeffrey J AU - Teuteberg JJ AD - Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, Department of Medicine, Stanford University, Stanford, California, USA. Electronic address: jeff.teuteberg@stanford.edu. LA - eng PT - Journal Article DEP - 20190107 PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 RN - 0 (Glucocorticoids) RN - 0 (Immunosuppressive Agents) RN - VB0R961HZT (Prednisone) SB - IM MH - Adult MH - Cohort Studies MH - Cytomegalovirus Infections/epidemiology MH - Female MH - Gene Expression Profiling MH - Glucocorticoids/therapeutic use MH - Heart Failure/etiology/mortality/*surgery MH - Heart Transplantation/*adverse effects MH - Hospitalization MH - Humans MH - Immunosuppressive Agents/therapeutic use MH - Male MH - Middle Aged MH - Postoperative Complications/*epidemiology/*microbiology MH - Prednisone/therapeutic use MH - Risk Factors MH - Time Factors OTO - NOTNLM OT - AlloMap OT - cytomegalovirus OT - heart transplantation OT - immunosuppression OT - infectious episode OT - survival EDAT- 2019/02/02 06:00 MHDA- 2020/11/11 06:00 CRDT- 2019/02/02 06:00 PHST- 2018/04/17 00:00 [received] PHST- 2018/12/19 00:00 [revised] PHST- 2019/01/03 00:00 [accepted] PHST- 2019/02/02 06:00 [pubmed] PHST- 2020/11/11 06:00 [medline] PHST- 2019/02/02 06:00 [entrez] AID - S1053-2498(19)30006-3 [pii] AID - 10.1016/j.healun.2019.01.006 [doi] PST - ppublish SO - J Heart Lung Transplant. 2019 Jun;38(6):611-618. doi: 10.1016/j.healun.2019.01.006. Epub 2019 Jan 7.