Background

Post-transplant infections are associated with high mortality rates. This retrospective nationwide cohort study examined the incidence and risk factors of infections requiring hospitalization after heart transplantation and the associated economic burden.

Methods

The entire heart transplant recipients' data from the Korean Health Insurance Review and Assessment Service between 2013 and 2020 was used. We estimated the annual incidence of post-transplant infections and adjusted incidence rate ratios (aIRR) of risk factors for reported infections using the poisson generalized linear model.

Results

Among 1,030 heart transplant recipients (324 with and 706 without post-transplant infections), 0.45 post-transplant infections were reported annually, with respiratory tract infections constituting the highest proportion (0.16). The risk of post-transplant infections was high in recipients with renal failure (aIRR = 1.35; 95% confidence interval [CI], 1.05–1.75) or nosocomial infection (aIRR = 1.47; 95% CI, 1.15–1.87). Combination regimens, including mammalian target of rapamycin inhibitor (mTORi), did not differ significantly from the standard 3 drug regimen (aIRR = 1.16; 95% CI, 0.80–1.67). The risk of death was higher among recipients with post-transplant infections than in uninfected recipients (adjusted hazard ratio = 4.59; 95% CI, 2.19–9.65). The mean follow-up cost per patient per month was 2-fold higher in recipients with post-transplant infections than in uninfected recipients ($5,096 and $2,532, respectively; p < .001).

Conclusions

mTORi combination, which reportedly maintains renal function, can be considered, as it does not increase the infection risk. Post-transplant infections present clinical and economic burdens, warranting careful observation of at-risk patients.

中文翻译：

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心脏移植后移植后感染的临床影响和经济负担：一项全国性回顾性队列研究

背景

移植后感染与高死亡率有关。这项回顾性的全国性队列研究检查了心脏移植后需要住院的感染的发生率和危险因素以及相关的经济负担。

方法

使用了 2013 年至 2020 年间来自韩国健康保险审查和评估服务的整个心脏移植受者的数据。我们使用泊松广义线性模型估计了移植后感染的年发病率和报告感染风险因素的调整发病率比 (aIRR)。

结果

在 1,030 名心脏移植受者（324 名移植后感染和 706 名未移植后感染）中，每年报告 0.45 例移植后感染，呼吸道感染占最高比例（0.16）。肾功能衰竭（aIRR = 1.35；95% 置信区间 [CI]，1.05-1.75）或医院感染（aIRR = 1.47；95% CI，1.15-1.87）的受者移植后感染的风险很高。联合方案，包括哺乳动物雷帕霉素抑制剂靶点 (mTORi)，与标准 3 药物方案没有显着差异（aIRR = 1.16；95% CI，0.80-1.67）。移植后感染受者的死亡风险高于未感染受者（调整后的风险比 = 4.59；95% CI，2.19-9.65）。p < .001)。

结论

可以考虑使用 mTORi 组合，据报道它可以维持肾功能，因为它不会增加感染风险。移植后感染会带来临床和经济负担，需要仔细观察高危患者。