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Analysis of 200 Episodes

Mordechai R. Kramer, MD; Sara E. Marshall, MBBCh; Vaughn A. Starnes, MD; Pat Gamberg, RN; Ziva Amitai, MD; James Theodore, MD

Arch Intern Med. 1993;153(17):2010-2016.

Abstract
Background
Infection remains an important cause of morbidity and mortality in heart-lung transplant recipients. This study was designed to assess the frequency, type, and timing of infection in heart-lung transplant recipients.

Methods
A retrospective analysis of 200 episodes of serious infections occurring in 73 heart-lung recipients at Stanford (Calif) University Medical Center between 1981 and 1990.

Results
Bacterial infections accounted for half of all infections, with the highest incidence in the first month after transplantation. Fungal infections (14%) were also common in the first month. Cytomegalovirus was the most common viral agent (15%), occurring primarily in the second month after transplantation. Other viruses (herpes simplex, adenovirus, and respiratory syncytial virus) accounted for a further 15% of total infections. Pneumocystis carinii infections were common 4 to 6 months after transplantation, and Nocardia typically infected recipients later than 1 year after transplantation. There was no significant difference in incidence of infections between patients receiving triple (cyclosporine, prednisone, immuran) or double (cyclosporine and prednisone) immunosuppression therapy. Mortality due to infection accounted for 40% of all deaths.

Conclusions
Knowledge of the incidence and timing of infection should help in the prevention, early detection, and initiation of therapy in these patients.

(Arch Intern Med. 1993;153:2010-2016)

Author Affiliations
From the Departments of Medicine (Drs Kramer, Marshall, Amitai, and Theodore) and Cardiovascular Surgery (Dr Starnes and Ms Gamberg), Stanford (Calif) University School of Medicine.

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