Murphy Katie M, Vikram Holenarasipur R
Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona.
Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona.
Transpl Infect Dis. 2019 Feb;21(1):e13006. doi: 10.1111/tid.13006. Epub 2018 Oct 28.
Active infection in the recipient is considered a relative contraindication for solid organ transplantation. However, heart transplantation (HT) can be curative in patients with ventricular assist device infections. For patients with infective endocarditis (IE), valve replacement is part of the management strategy based on emergent, acute, or elective indications. HT has been utilized as an uncommon and sporadic treatment option for carefully selected patients with refractory or recurrent IE after all other surgical treatment options have been exhausted or are not feasible. Herein, we review 19 published cases of IE in whom HT was undertaken in the setting of ongoing active infection with reported good outcomes. We attempt to propose general criteria for HT in the setting of IE and discuss challenges and hurdles that clinicians might encounter when considering HT for active IE in the absence of robust data or clearly defined criteria.
受体的活动性感染被认为是实体器官移植的相对禁忌证。然而，心脏移植（HT）对于心室辅助装置感染的患者可能具有治愈作用。对于感染性心内膜炎（IE）患者，瓣膜置换是基于紧急、急性或择期指征的治疗策略的一部分。对于经过仔细挑选、在所有其他手术治疗方案均已用尽或不可行的情况下患有难治性或复发性IE的患者，HT已被用作一种罕见且偶发的治疗选择。在此，我们回顾了19例已发表的在活动性感染情况下进行HT且报告有良好预后的IE病例。我们试图提出在IE情况下进行HT的一般标准，并讨论临床医生在缺乏有力数据或明确标准的情况下考虑对活动性IE进行HT时可能遇到的挑战和障碍。
