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Invasive Fungal Infections in Orthotopic Heart Transplant Patients: Incidence and Risk Factors in the Modern Era

Summary

This study examined fungal infections in heart transplant patients at Cleveland Clinic between 2010-2020. Researchers found that about 5% of heart transplant patients developed serious fungal infections, with Candida being the most common culprit. Patients with previous fungal infections, those who needed additional surgeries after transplant, and those requiring life support machines (ECMO) had the highest risk. Heart transplant patients with fungal infections had much worse survival rates, suggesting the need for better prevention strategies using antifungal medications.

Background

Invasive fungal infections (IFI) in orthotopic heart transplant (OHT) patients carry high morbidity and mortality, with reported incidence ranging from 3.4% to 10%. The characteristics of OHT candidates have changed substantially, with increased transplantation of older patients, those with more comorbidities, and those supported with mechanical circulatory support devices.

Objective

To identify the incidence of IFI and determine risk factors for IFI among OHT patients transplanted between 2010-2020 to inform targeted prevention strategies in the modern era.

Results

Of 548 patients, 29 experienced IFI (incidence 5.3%, 95% CI 3.7-7.5). Candida was the most common pathogen (51%), followed by Aspergillus (27%) and Cryptococcus (9%). Independent risk factors for IFI were pretransplant fungal colonization/infection (OR 27), post-transplant reoperation (OR 5.8), and ECMO cannulation (OR 3.1). One-year survival was significantly worse in patients with IFI (76% vs 97%, p<0.01).

Conclusion

Specific, identifiable risk factors during pre- and post-transplant periods are associated with increased odds of IFI in OHT patients. These findings merit study of targeted antifungal prophylaxis with broad yeast and mold activity in high-risk OHT patients. Historical risk factors like CMV viremia, diabetes, and rejection were not significant in this contemporary cohort.
  • Published in:Clinical Transplantation,
  • Study Type:Retrospective Cohort Study,
  • Source: PMID: 40747869, DOI: 10.1111/ctr.70248
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