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논문KCI 등재

국내의 심장 이식 환자에서 발생한 감염 합병증의 임상 양상 및 예후

Clinical Features and Outcome of Infectious Complications in Heart Transplant Recipients in Korea

송재훈|이정아|문수연|백경란|정두련|강철인|전은석|박표원|정미경
대한감염학회 (The Korean Society Of Infectious Diseases)|2010.12|Infection and Chemotherapy|제42권 제6호|pp. 375-382

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참고문헌

키워드

LungHeart transplantationInfectious complication
주제분류내과학

초록

Background: Although heart transplantation is the only therapeutic modality for patients with end-stage heart disease, immunosuppressive therapy to reduce organ rejection may increase the risk of infection in transplant patients. Little is known regarding infectious complications in heart transplant recipients in Korea. Thus, this study was performed to evaluate the clinical features and outcome of infectious complications in patients receiving heart transplantation. Materials and Methods: A retrospective cohort study was performed by reviewing medical records of patients who underwent heart transplantation from December 1996 to October 2008 in Samsung Medical Center, Seoul, Korea. Results: A total of 72 cardiac allograft recipients were included in the analysis. Median follow-up duration was 417 (range, 2-3995) days. During the follow-up period, 75 infectious complications occurred in 39 (54.2%) recipients, of which 31 cases (41.3%) were caused by bacteria, 28 (37.3%) by viruses, 10 (13.3%)by fungi, 4 (5.4%) by Pneumocystis jirovecii , and 2 (2.7%) by Mycobacterium tuberculosis . Median onset time of bacterial, viral and fungal infection were 153,106 and 68 days, respectively. The most common site of infection was lung (n=26,34.7%), followed by gastrointestinal tract (n=11, 14.7%) and oral cavity (n=9, 12%). All patients were sero-positive for cytomegalovirus (CMV)-specific IgG before transplantation and received preemptive therapy of CMV infection. After heart transplantation, 44 (63.8%) patients experienced CMV reactivation identified by CMV antigenemia and 9 (13%) patients had organ-specific CMV diseases. The overall mortality rate was 33.3% (24/72). Infectious complications were the most common cause of death (n=10, 41.7%). The operative risk factors for death were lung infection, fungal infection and bloodstream infection. Conclusions: In the current study, the lung was the most common site of infection and bacteria were the most frequent etiologic pathogens among heart transplant recipients. Infectious complications, especially fungal infections were the most common causes of death. Prevention strategies against fungal infections should be evaluated in the future studies.

Abstract

Background: Although heart transplantation is the only therapeutic modality for patients with end-stage heart disease, immunosuppressive therapy to reduce organ rejection may increase the risk of infection in transplant patients. Little is known regarding infectious complications in heart transplant recipients in Korea. Thus, this study was performed to evaluate the clinical features and outcome of infectious complications in patients receiving heart transplantation. Materials and Methods: A retrospective cohort study was performed by reviewing medical records of patients who underwent heart transplantation from December 1996 to October 2008 in Samsung Medical Center, Seoul, Korea. Results: A total of 72 cardiac allograft recipients were included in the analysis. Median follow-up duration was 417 (range, 2-3995) days. During the follow-up period, 75 infectious complications occurred in 39 (54.2%) recipients, of which 31 cases (41.3%) were caused by bacteria, 28 (37.3%) by viruses, 10 (13.3%)by fungi, 4 (5.4%) by Pneumocystis jirovecii , and 2 (2.7%) by Mycobacterium tuberculosis . Median onset time of bacterial, viral and fungal infection were 153,106 and 68 days, respectively. The most common site of infection was lung (n=26,34.7%), followed by gastrointestinal tract (n=11, 14.7%) and oral cavity (n=9, 12%). All patients were sero-positive for cytomegalovirus (CMV)-specific IgG before transplantation and received preemptive therapy of CMV infection. After heart transplantation, 44 (63.8%) patients experienced CMV reactivation identified by CMV antigenemia and 9 (13%) patients had organ-specific CMV diseases. The overall mortality rate was 33.3% (24/72). Infectious complications were the most common cause of death (n=10, 41.7%). The operative risk factors for death were lung infection, fungal infection and bloodstream infection. Conclusions: In the current study, the lung was the most common site of infection and bacteria were the most frequent etiologic pathogens among heart transplant recipients. Infectious complications, especially fungal infections were the most common causes of death. Prevention strategies against fungal infections should be evaluated in the future studies.

참고문헌 (31)

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