Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

Table 1 Selected characteristics of heart transplant recipients according to multidrug-resistant organism presence

Heart transplant recipients	Total (n = 98)	MDRO presence (n = 32)	MDRO-free (n = 66)	P value
Demographics
Age (yr)	50 (37-56)	51 (41-56)	45.5 (35.5-56)	0.48
Sex (male)	69 (70.4)	25 (78.1)	44 (66.7)	0.24
Height (cm), SD	172 (9)	174 (8)	172 (9)	0.25
Body weight (kg), SD	75 (15)	81 (11)	72 (16)	0.002
ΒΜΙ (kg/m2), SD	25.1 (3.8)	26.9 (3)	24.3 (3.9)	0.001
Heart failure etiology
Non-ischemic cardiomyopathy	75 (76.5)	23 (71.9)	52 (78.8)	0.45
Ischemic cardiomyopathy	22 (22.4)	8 (25)	14 (21.2)	0.67
Comorbidities
Diabetes mellitus	21 (21.4)	8 (25)	13 (19.7)	0.54
CRF (eGFR ≤ 60 mL/min/m2)	13 (13.3)	8 (25)	5 (7.6)	0.017
Vasculopathy	40 (40.8)	17 (53.1)	23 (34.8)	0.08
COPD	5 (5.1)	2 (6.3)	3 (4.5)	0.72
Previous cardiac surgery	18 (18.4)	24 (75)	38 (57.6)	0.09
Smoking history	55 (56.7)	21 (65.6)	34 (52.3)	0.21
Status at transplantation
VAD	54 (55.1)	22 (68.8)	32 (48.5)	0.06
Admitted from home	65 (66.3)	20 (62.5)	45 (68.2)	0.10
Admitted from ward	15 (15.3)	5 (15.6)	10 (15.2)	0.95
Admitted from ICU	18 (18.4)	7 (21.9)	11 (16.7)	0.53
Operating room
General anesthesia (hours)	7 (6-8)	6.5 (6-8)	7 (6-8)	0.84
Extracorporeal circulation (min)	168 (144-229)	210 (146-271)	161 (141-193)	0.003
Aorta closure (min)	115 (77-198)	115 (85-130)	115 (67-211)	0.94
Transfusion (RBC units)	4 (2-10)	9.5 (4-13)	4 (2-7)	0.001
Post transplantation
Primary graft dysfunction	13 (13.3)	10 (31)	3 (4.5)	0.001
Surgical re-exploration	20 (20.4)	11 (34)	9 (13.6)	0.017
Ventilator days	2 (1-5)	5 (3-3.5)	1.3 (1-3)	0.001
NO for refractory hypoxemia	25 (25.5)	14 (43.8)	11 (16.7)	0.04
CRRT for renal failure	15 (15.3)	9 (28)	6 (9)	0.014
Post Tx mechanical circulatory support	32 (32.7)	15 (46.9)	17 (25.8)	0.037
ATG treatment (days)	5 (4-7)	6 (5-8)	5 (4-6)	0.08
Outcomes
ICU stay, days	10 (7-17)	15.5 (10-26)	9 (7-12)	0.001
Post transplantation total hospital stay, days	30 (24-41)	38 (25-62)	28 (21-39)	0.006
Early mortality (30 d)	9 (1)	6 (18.8)	3 (4.5)	0.02
Late mortality (1-year)	14 (14.3)	9 (28.1)	5 (7.6)	0.006
Died in ICU	12 (12.2)	8 (25)	4 (6)	0.003

Categorical values are given as absolute numbers and percentages. Normally distributed continuous variables (weight, height, body mass index) are given as mean values with SD. Continuous variables non-normally distributed are given as median with percentiles (25-75^th). ATG: Anti-thymocyte globulin; BMI: Body mass index; CRRT: Continuous renal replacement treatment; ICU: Intensive care unit; NO: Nitric oxide; VAD: Ventricular assist device; COPD: Chronic obstructive pulmonary disease; MDRO: Multidrug-resistant organism; CRF: Chronic renal failure.

Table 2 Patients who received a heart from a bacteremic donor and developed multidrug-resistant organism bacteremia post-transplantation

Patient	1	2	3	4
Diagnosis	DCM	DCM	DCM	DCM
Age (yr)	21	53	58	61
Sex	M	F	M	M
Device pre-transplant	BiVAD	IABP	LVAD	LVAD
Comorbidities	-	DM	-	CRF, vasculopathy
Admitted from (days of stay pre-transplant)	Ward (3 d)	Cardiac ICU (123 d)	Home	Ward (36 d)
Recipient MDRO colonization pre-transplant	No	No	No	No
MDRO donor bacteremia	Acinetobacter baumannii	Acinetobacter baumannii	Acinetobacter baumannii	Pseudomonas aeruginosa
Post-transplant complications	Re-exploration for hemorrhage	IABP (3 d)	IABP (9 d), re-exploration for hemorrhage	-
Septic shock	No	No	Yes	No
Post-transplant ICU stay	10 d	8 d	27 d (death)	11 d
Post-transplant total hospital stay	35 d	50 d	27 d (death)	34 d
Outcome (1 yr)	Fully functional at home	Fully functional at home	Death (day 27) due to thromboembolism/MOF	Partially dependent at home, frequent readmissions

BiVAD: Bi-ventricular assist device; CRF: Chronic renal failure; DCM: Dilated cardiomyopathy; IABP: Intra-aortic balloon pump; ICU: Intensive care unit; LVAD: Left ventricular assist device; MOF: Multiple organ failure; MDRO: Multidrug-resistant organism.