Frequency of infections and their relation to episodes of acute rejection among heart allograft recipients.

OBJECTIVES

Infections and episodes of acute rejections are major factors affecting allograft survival during the first year after transplantation. The frequency of infections, and the relation of injections to rejection episodes were studied among heart allograft recipients with the follow-up time one year.

METHODS

The study population consisted of 58 patients receiving a heart allograft through 1985 to 1990. Low-dose triple-drug therapy was used for immunosuppression, and rejections were treated either with methylprednisolone, antithymocyte globulin, or the combination of methylprednisolone and antithymocyte globulin. The patients received 2 g of vancomycin i.v. 2 days postoperatively, and no further antibacterial prophylaxis was used. The diagnosis of infection was based on clinical symptoms and on microbiological or serological demonstration of an infection. When the correlations between severe infections and rejections were examined, only infections occurring within 1 month from the onset of the rejection were included. Chi-square test was used for statistical analysis.

RESULTS

Seventy-nine infections were registered (1.6 +/- 1.4 episodes/patients); 74% of the patients underwent at least one infection episode. Most infections, 61% (49), occurred during the first three posttransplant months, cytomegalovirus and bacterial agents accounting for the most important aetiology. No difference in the overall infection frequency existed between the patients with or without rejections. Twenty seven infection episodes were recorded in 18/50 patients with rejections (p = NS), 11 of them in relation to rejection in 5/18 patients. The frequency of infections after antirejection therapy either with antithymocyte globulin or the combination of methylprednisolone and antithymocyte globulin (7/11) was higher than with methylprednisolone alone (4/20) (p < 0.05). Infections were the primary cause of death in 50%. The rest of deaths were caused by acute rejections.

CONCLUSION

There was a typical pattern of infections occurring mainly during the first three months after transplantation, and a significant tendency towards severe infections after intense antirejection therapy with antithymocyte globulin.