Miller L W, Naftel D C, Bourge R C, Kirklin J K, Brozena S C, Jarcho J, Hobbs R E, Mills R M
Cardiac Transplant Research Database Center, University of Alabama at Birmingham.
J Heart Lung Transplant. 1994 May-Jun;13(3):381-92; discussion 393.
The incidence, causes, and impact of acute infection were analyzed among 814 consecutive patients from 24 institutions undergoing primary heart transplantation between January 1, 1990, and June 30, 1991, with mean follow-up of 8.2 months (range 0 to 18 months). Sixty-nine percent of the patients had no infections during the follow-up, whereas 31% of patients had one or more infection episodes. The cumulative incidence of infections per patient was 0.41 at 3 months, 0.55 at 6 months, and 0.62 at 12 months after transplantation. Bacterial and viral infections were most common (47% and 41% of infections), with fungi and protozoa accounting for 12%. Overall mortality per infection was 13%, but mortality with fungal infections was higher (36%, p < 0.0001). The most common organ infected was the lung, with a mortality of 23%. The probability of infection by 12 months was higher when OKT3 or antithymocyte globulin induction therapy was used (41% versus 35%, p = 0.01). The single most frequent infecting organism was cytomegalovirus, accounting for 26% of all infections. The probability of cytomegalovirus infection by 12 months was increased with a cytomegalovirus-positive donor and cytomegalovirus-negative recipient (27% versus 15% in all others, p < 0.0001) and with the use of OKT3 or antithymocyte globulin induction therapy (19% versus 12% without induction therapy, p = 0.07). Infection remains the leading cause of death after heart transplantation. The hazard function of likelihood of developing each type of infection at various times after transplantation, as well as response to therapy, are discussed.
对1990年1月1日至1991年6月30日期间来自24家机构的814例接受初次心脏移植的连续患者进行了急性感染的发生率、病因及影响分析，平均随访8.2个月（范围0至18个月）。69%的患者在随访期间未发生感染，而31%的患者发生了一次或多次感染事件。移植后3个月时每位患者感染的累积发生率为0.41，6个月时为0.55，12个月时为0.62。细菌和病毒感染最为常见（分别占感染的47%和41%），真菌和原生动物感染占12%。每次感染的总体死亡率为13%，但真菌感染的死亡率更高（36%，p<0.0001）。最常受感染的器官是肺，死亡率为23%。使用OKT3或抗胸腺细胞球蛋白诱导治疗时，12个月时感染的概率更高（41%对35%，p=0.01）。最常见的感染病原体是巨细胞病毒，占所有感染的26%。供体巨细胞病毒阳性而受体巨细胞病毒阴性时，12个月时巨细胞病毒感染的概率增加（27%对其他所有情况的15%，p<0.0001），使用OKT3或抗胸腺细胞球蛋白诱导治疗时也增加（诱导治疗组为19%，未诱导治疗组为12%，p=0.07）。感染仍然是心脏移植后死亡的主要原因。文中讨论了移植后不同时间发生每种感染类型的可能性的风险函数以及对治疗的反应。
