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Master Thesis

Épidémiologie et facteurs de risque des infections en post opératoire de transplantation cardiaque

Abstract : Introduction: Immunosuppressive therapy used after heart transplantation predispose recipients to post-operative infection and is associated with potential worse outcomes. The objective of this study was to investigate the epidemiology and the risk factors of post-operative infection in recipients beneficing of heart transplantation. Material and Methods: We investigated all patients underwent heart transplantation between January 2014 and December 2015. All the post-operative infections occurring during hospitalization were recorded. The "infected" and "non-infected" patients were compared by Wilcoxon or Fisher tests. A test of Log Rank and a Cox model was used for univariate and multivariate analysis. Results: At all, 175 recipients were retrospectively investigated and 233 post-operative infections occurred in 119 patients (68% of the recipients). Main infections were pneumoniae (89) and infections of inguinal cannulation site (60) after veno-arterial Extracorporeal Membrane Oxygenation (VA ECMO). In multivariate analysis, risk factors of post-operative infection were VA ECMO before transplantation (OR : 1,16 [IC95 :1,00-1,35], p=0,04) and after transplantation (OR : 1,28 [IC95 :1,10-1,48], p < 0,01), blood transfusion > 2 units packed cell (OR : 1,21 [IC95: 1.05-1.39], p<0.01. Plasmapheresis and IV Immunoglobulins were not associated with an increased risk of infection. Mechanical ventilation, ECMO device and hospitalization were longer in infected patients. Rejections were similar between the two groups. One year mortality tends to be higher in infected patients but without leading significance level, (7% vs 15%, OR 2.9 (0.8-10.3) p=0.15). Conclusion: Post-operative infections are frequent after heart transplantation, mainly pneumonias and infections of cannulation site. ECMO before and after the heart transplantation, and blood transfusion increase this risk, and prolong mechanical ventilation and the duration of hospitalization. Prophylactic treatment of humoral rejection in sensitized recipient is not associated with higher rate of infection. In this cohort of recipients, mortality is not significantly increased.
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Master Thesis
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Romain Pasqualotto. Épidémiologie et facteurs de risque des infections en post opératoire de transplantation cardiaque. Médecine humaine et pathologie. 2017. ⟨dumas-01791768⟩

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