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LVAD bloodstream infections: therapeutic rationale for transplantation after LVAD infection.
Robert S Poston; Shahid Husain; Damian Sorce; Ellieen Stanford; Shimon Kusne; Margaret Wagener; Bartley P Griffith; Robert L Kormos (Profiled Author: Bartley P Griffith)
Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2003;22(8):914-21.
INTRODUCTION: Patients who have ventricular assist devices (VADs) and experience bloodstream infection (BSI) have high mortality. We addressed 2 questions raised by the United Network for Organ Sharing (UNOS) priority policy for this problem: 1) Are organs wasted on this ultra-high-risk group? 2) Can device-related BSI be differentiated from transient BSI? METHODS: Patients with VADs who underwent heart transplantation from 1987 to 2001, who had BSI during VAD support, and who had positive cultures at VAD explant (device-related BSI, n = 10) were compared with those with negative cultures at explant (non-device-related BSI, n = 11). RESULTS: Patients with device-related BSI had an 80% (8/10) rate of persistent bacteremia; 30 days and 1 year after transplantation, mortality was 14% and 26%, respectively. Non-device-related BSI (n = 11) persisted in 18% (2/11); peri-operative and 1-year mortalities were 9% and 13%. Duration of VAD support predicted infection (132 vs 48 days, p < 0.001); hypo-albuminemia (2.9 +/- 0.5 mg/dl vs 3.3 +/- 0.8 mg/dl, p < 0.05), and a resistant organism predicted a device-related BSI. These patients had increased intubation requirements and had increased creatinine concentration during the first post-operative week, with no difference in liver function, blood loss, transfusions (packed red blood cells, fresh frozen plasma, or platelets), or hemodynamic stability vs patients with non-device BSI. Despite decreased immunosuppression, we found no difference in acute rejection events with device-related BSI. Re-infection with the pre-operative organism occurred in only 1 patient per group. CONCLUSIONS: These data suggest that urgent (Status 1A) cardiac transplantation is effective in stable patients with device-related BSI, and these data support the current UNOS policy. However, an extra-device source of BSI should be excluded by considering the isolated organism, the baseline nutritional status, and other risk factors.
This section shows information related to the publication - computed using the fingerprint of the publication - including related publications, related experts and related grants with fingerprints representing significant amounts of overlap between their fingerprint and this publication. The red dots indicate whether those experts or terms appear within the publication, thereby showing potential and actual connections.
R L Kormos; T A Gasior; A Kawai; S M Pham; S Murali; B G Hattler; B P GriffithThe Journal of thoracic and cardiovascular surgery 1996;111(4):773-82; discussion 782-3.
Mani A Daneshmand; Keshava Rajagopal; Brian Lima; Nikta Khorram; Laura J Blue; Andrew J Lodge; Adrian F Hernandez; Joseph G Rogers; Carmelo A MilanoThe Annals of thoracic surgery 2010;89(4):1205-9; discussion 1210.
B P Griffith; R L Kormos; C J Nastala; S Winowich; J M PristasThe Annals of thoracic surgery 1996;61(1):396-8; discussion 407.
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