Infective endocarditis following heart transplantation: A systematic review

Andrew M Jordan; Robert Tatum; Danial Ahmad; Sonali V Patel; Elizabeth J Maynes; Matthew P Weber; Sean Moss; Tricia L Royer; Vakhtang Tchantchaleishvili; H Todd Massey; J Eduardo Rame; John J Zurlo; Nana Aburjania

doi:10.1016/j.trre.2021.100672

Infective endocarditis following heart transplantation: A systematic review

Transplant Rev (Orlando). 2022 Jan;36(1):100672. doi: 10.1016/j.trre.2021.100672. Epub 2021 Nov 6.

Affiliations

¹ Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
² Division of Infectious Disease, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
³ Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁴ Division of Infectious Disease, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: aburjania@gmail.com.

PMID: 34826752
DOI: 10.1016/j.trre.2021.100672

Abstract

Purpose: Infective endocarditis (IE) is a rare but potentially fatal complication following heart transplantation (HTx). There is a lack of literature regarding the patterns and clinical course of IE development following HTx. We sought to pool the existing data in regards to defining characteristics, management options, and outcomes of IE following HTx.

Methods: An electronic search of Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, and the Scopus databases were performed to identify all articles in the English literature that report IE following HTx in adult patients. Patient-level data were extracted and analyzed.

Results: Systematic search yielded 57 patients from 32 articles. Median patient age was 52 [IQR 43, 59] and 75% of patients (43/57) were male. Median time to IE presentation post-HTx was 8.4 [IQR 3.0, 35.8] months. IE of the mitral valve was observed in 36.8% (21/57) of patients, followed by mural IE in 24.6% (14/57), and tricuspid valve IE in 21.1% (12/57). The most common organisms were Staphylococcus aureus in 26.3% (15/57), Aspergillus fumigatus in 19.3% (11/57), Enterococcus faecalis in 12.3% (7/57), and an undetermined or unspecified organism in 14.0% (8/57) patients. Overall case fatality was 44.6% (25/56). Fungal IE was associated with a significantly higher case fatality 75.0% (9/12) than that of bacterial IE 36.1% (13/36) (p = 0.02). Surgical management of post-HTx IE was observed in 35.1% (20/57) of patients. This included valve surgery for 70.0% (14/20), including the mitral valve in 50.0% (7/14), aortic valve in 35.7% (5/14), and the tricuspid valve in 14.3% (2/14) of patients.

Conclusion: In addition to bacterial organisms, fungi also represent a frequent cause of IE in post-HTx patients. Overall HTx patient survival in the setting of IE is poor and may be worse if caused by A. fumigatus.

Keywords: Endocarditis; Heart transplantation; Infectious endocarditis; Transplantation.

Publication types

Review
Systematic Review

MeSH terms

Adult
Endocarditis* / microbiology
Endocarditis, Bacterial* / etiology
Endocarditis, Bacterial* / microbiology
Heart Transplantation* / adverse effects
Humans
Male
Staphylococcal Infections* / complications
Staphylococcal Infections* / microbiology
Staphylococcus aureus