Department of Infectious Diseases, Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
Transplant Infectious Diseases, Transplant Center, Cleveland Clinic Foundation, Cleveland, Ohio.
Clin Transplant. 2019 Sep;33(9):e13552. doi: 10.1111/ctr.13552. Epub 2019 Apr 29.
The Infectious Diseases Community of Practice of the American Society of Transplantation has published evidenced-based guidelines on the prevention and management of infectious complications in SOT recipients since 2004. This updated guideline reviews the epidemiology of ventricular assist device (VAD) infections and provides recommendations for the management and prevention of these infections. Almost one half of those awaiting heart transplantation are supported with VADs. Despite advances in device technologies, VAD infections commonly complicate mechanical circulatory support and remain typified by common components and anatomic locations. These infections have important implications for transplant candidates, most notably increased wait-list mortality. Strategic management of these infections is crucial for successful transplantation. Coincidentally, explantation of all VAD components at the time of transplantation is often the definitive cure for the device-associated infection. Highlighted in this updated guideline is the reported success of transplantation in patients with a variety of pre-existing VAD infections and guidance on post-transplant management strategies.
自 2004 年以来,美国移植学会传染病实践社区已经发布了有关预防和管理 SOT 受者感染并发症的循证指南。本更新指南回顾了心室辅助装置 (VAD) 感染的流行病学,并提供了这些感染的管理和预防建议。近一半等待心脏移植的患者都接受了 VAD 支持。尽管设备技术取得了进步,但 VAD 感染仍是机械循环支持的常见并发症,其特征是常见的组成部分和解剖部位。这些感染对移植候选人有重要影响,尤其是增加了等待名单上的死亡率。这些感染的策略性管理对于成功移植至关重要。巧合的是,在移植时将所有 VAD 组件一并取出通常是治疗与设备相关感染的有效方法。本更新指南强调了在各种先前存在的 VAD 感染患者中移植成功的报道,并提供了有关移植后管理策略的指导。