Infections in the first year after heart transplantation in a Latin American country.

BACKGROUND: Heart transplantation is the therapy of choice in patients with advanced heart failure refractory to other medical or surgical management. However, heart transplants are associated with complications that increase posttransplant morbidity and mortality. Infections are one of the most important complications after this procedure. Therefore, infections in the first year after heart transplantation were evaluated. METHODS: A retrospective cohort study of infections after heart transplants was conducted in a teaching hospital in Colombia between 2011 and 2019. Patients registered in the institutional heart transplant database (RETRAC) were included in the study. Microbiological isolates and infectious serological data were matched with the identities of heart transplant recipients and data from clinical records of individuals registered in the RETRAC were analyzed. The cumulative incidences of events according to the type of microorganism isolated were estimated using Kaplan-Meier survival analyses. RESULTS: Seventy-nine patients were included in the study. Median age was 49 years (37.4-56.3), and 26.58% of patients were women. Eighty-seven infections were documented, of which 55.17% (48) were bacterial, 22.99% (20) were viral, and 12.64% (11) were fungal. Bacterial infections predominated in the first month. In the first year, infections caused 38.96% of hospital admissions and were the second cause of death after heart transplants (25.0%). CONCLUSION: Posttransplant infections in the first year of follow-up were frequent. Bacterial infections predominated in the early posttransplant period. Infections, mainly bacterial, were the second most common cause of death and the most common cause of hospitalization in the first year after heart transplantation.

American Registry of Ambulatory or acutely decompensated heart failure (AMERICCAASS Registry): First 1000 patients.

BACKGROUND: About 80% of cardiovascular diseases (including heart failure [HF]) occur in low-income and developing countries. However, most clinical trials are conducted in developed countries. HYPOTHESIS: The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America. METHODOLOGY: Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro-Wilk test. RESULTS: This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7-75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta-blockers (BB), 77.4% for angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor-neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium-glucose cotransporter type-2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet-warm (68.3%). CONCLUSIONS: AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two-thirds do not receive SGLT2i.

Posterior Reversible Encephalopathy Syndrome Associated with Tacrolimus in Cardiac Transplantation.

BACKGROUND: Neurological complications occur between 50 and 70% of patients with heart transplantation, including cerebrovascular events, infections, seizures, encephalopathy, and neurotoxicity due to pharmacological immunosuppression. Mortality associated with cerebrovascular complications is 7.5% in the first 30 days and up to 5.3% after the first month and up to the first year after transplantation. Case Reports. Three heart-transplanted patients (2 men and 1 woman) treated with tacrolimus were identified. They presented with posterior reversible encephalopathy syndrome on days 5, 6, and 58 posttransplantation, respectively. In these reported cases, no sequelae were observed at 6 months follow-up. CONCLUSIONS: Posterior reversible encephalopathy syndrome as a neurological complication in patients with HT occurred early after the procedure. Early diagnosis and treatment might reduce the risk of serious complications and mortality.

Factores asociados a la mortalidad en el primer año postrasplante cardíaco / Factors associated with mortality in the first year post-cardiac transplantation

Resumen Introducción: en el trasplante cardiaco la sobrevida es del 81 al 85% en el primer año; las infecciones y la falla del injerto son las principales causas de mortalidad. Objetivo: determinar los factores de riesgo asociados a mortalidad al año postrasplante cardiaco en un hospital de alta complejidad del suroccidente colombiano. Métodos: cohorte retrospectiva de pacientes con trasplante de corazón llevado a cabo entre 1996 a 2015. Se obtuvo la información de las características del donante, receptor y procedimiento quirúrgico. Se realizó una regresión de Cox; el evento de interés fue la mortalidad al primer año de seguimiento. En el análisis multivariable se incluyeron variables con p ≤ 0,20 y significancia clínica. Resultados: se incluyeron 158 pacientes, con mediana de edad de 50 años (RIC: 39-57), 76% hombres. La principal etiología de falla cardiaca fue idiopática (45%). La mediana de tiempo de isquemia fue 187 minutos (RIC: 142-300). La mortalidad fue 24%, y se atribuyó principalmente a infecciones (29%). Fueron factores asociados a mortalidad la cardiopatía congénita como etiología de falla cardíaca (p 0,048), antecedente de diabetes mellitus (p 0,001), cirugía cardiaca previa (p 0,023) tiempo de isquemia mayor a 150 minutos (p 0,038) y relación receptor hombre/donante mujer (p 0,022). Conclusiones: los factores asociados a mayor mortalidad en el primer año postrasplante cardiaco fueron: etiología de la falla cardíaca por cardiopatía congénita, antecedente de diabetes mellitus, cirugía cardiaca previa, relación receptor hombre con donante mujer, tiempo de isquemia mayor a 150 minutos.

Abstract Introduction: The survival rate in the first year after heart transplant is between 81% and 85%. The main causes of mortality are infections and failure of the graft. Objective: To determine the risk factors associated with mortality at one year post- cardiac transplant in a high complexity hospital in south-west Colombia. Methods: A retrospective cohort study was performed on patients with a heart transplant carried out between 1996 and 2015. Information was obtained on the characteristics of the donor, recipient, and surgical procedure. A Cox regression was performed, with the event of interest being mortality in the first year of follow-up. In the multivariate analysis, variables were included that had a P≤ .20 and clinical significance. Results: The study included a total of 158 patients, with a median age of 50 years (IQR: 39-57), of whom 76% were males. The most common origin was idiopathic heart failure (45%). The median time of ischaemia was 187 minutes (IQR: 142-300). The mortality was 24% and was mainly due to infections (29%). There were factors associated with the congenital heart failure mortality such as origin of heart failure (P = .048), history of diabetes mellitus (P = .001), previous cardiac surgery (P = .023), ischaemia time greater than 150 minutes (P = .038), and the male recipient / female donor ratio (P = .022). Conclusions: The factors associated with higher mortality in the first year post-cardiac transplant were: origin of heart failure due to congenital heart disease, history of diabetes mellitus, previous cardiac surgery, the male recipient / female donor ratio, and an ischaemia time greater than 150 minutes.