Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Division of Infectious Disease, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Transplant Rev (Orlando). 2022 Jan;36(1):100672. doi: 10.1016/j.trre.2021.100672. Epub 2021 Nov 6.
Infective endocarditis (IE) is a rare but potentially fatal complication following heart transplantation (HTx). There is a lack of literature regarding the patterns and clinical course of IE development following HTx. We sought to pool the existing data in regards to defining characteristics, management options, and outcomes of IE following HTx.
An electronic search of Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, and the Scopus databases were performed to identify all articles in the English literature that report IE following HTx in adult patients. Patient-level data were extracted and analyzed.
Systematic search yielded 57 patients from 32 articles. Median patient age was 52 [IQR 43, 59] and 75% of patients (43/57) were male. Median time to IE presentation post-HTx was 8.4 [IQR 3.0, 35.8] months. IE of the mitral valve was observed in 36.8% (21/57) of patients, followed by mural IE in 24.6% (14/57), and tricuspid valve IE in 21.1% (12/57). The most common organisms were Staphylococcus aureus in 26.3% (15/57), Aspergillus fumigatus in 19.3% (11/57), Enterococcus faecalis in 12.3% (7/57), and an undetermined or unspecified organism in 14.0% (8/57) patients. Overall case fatality was 44.6% (25/56). Fungal IE was associated with a significantly higher case fatality 75.0% (9/12) than that of bacterial IE 36.1% (13/36) (p = 0.02). Surgical management of post-HTx IE was observed in 35.1% (20/57) of patients. This included valve surgery for 70.0% (14/20), including the mitral valve in 50.0% (7/14), aortic valve in 35.7% (5/14), and the tricuspid valve in 14.3% (2/14) of patients.
In addition to bacterial organisms, fungi also represent a frequent cause of IE in post-HTx patients. Overall HTx patient survival in the setting of IE is poor and may be worse if caused by A. fumigatus.
感染性心内膜炎（IE）是心脏移植（HTx）后一种罕见但潜在致命的并发症。关于 HTx 后 IE 发展的模式和临床过程，文献资料匮乏。我们旨在汇集有关成人 HTx 后 IE 定义特征、管理选择和结局的现有数据。
对 Cochrane 对照试验中心注册库、护理与联合健康文献累积索引、Ovid Medline 和 Scopus 数据库进行电子检索，以确定所有英文文献中报告 HTx 后 IE 的文章。提取并分析患者水平数据。
系统检索得到 32 篇文章中的 57 例患者。中位患者年龄为 52 岁[IQR 43，59]，75%（43/57）的患者为男性。中位 HTx 后 IE 发病时间为 8.4 [IQR 3.0，35.8] 个月。57 例患者中，二尖瓣 IE 占 36.8%（21/57），心内膜炎占 24.6%（14/57），三尖瓣 IE 占 21.1%（12/57）。最常见的病原体为金黄色葡萄球菌 26.3%（15/57），烟曲霉 19.3%（11/57），粪肠球菌 12.3%（7/57），14.0%（8/57）的患者为未确定或未明确病原体。总病死率为 44.6%（25/56）。真菌性 IE 的病死率明显高于细菌性 IE（75.0%，9/12）（36.1%，13/36）（p=0.02）。35.1%（20/57）的 HTx 后 IE 患者接受了手术治疗。这包括 70.0%（14/20）的瓣膜手术，包括二尖瓣 50.0%（7/14）、主动脉瓣 35.7%（5/14）和三尖瓣 14.3%（2/14）。
除细菌病原体外，真菌也是 HTx 后 IE 的常见病因。IE 患者的整体 HTx 生存率较差，如果由烟曲霉引起，可能更差。
