Predictive risk factors for postoperative pneumonia after heart transplantation.
BACKGROUND
Pneumonia is a frequent complication in patients undergoing heart transplantation (HTx) that increases morbidity and mortality in this population. Nevertheless, the risk factors for postoperative pneumonia (POP) are still unknown. The aim of this study was to investigate the predictive risk factors for POP in HTx recipients.


METHODS
In this retrospective study, all patients undergoing HTx between January 2014 and December 2015 were included. All cases of POP occurring until hospital discharge were investigated. The study aimed to determine risk factors using univariate and multivariate Cox regression models. Data are expressed in Odds Ratio [95% CI]. P < 0.05 was necessary to reject the null hypothesis.


RESULTS
A total of 175 patients were included without any patients being lost to follow-up, and 89 instances of POP were diagnosed in 59 (34%) patients. Enterobacteriaceae and Pseudomonas aeruginosa were the most common pathogens. In the multivariate analysis, the risk factors were preoperative mechanical ventilation (OR 1.42 [1.12-1.80], P < 0.01) and perioperative blood transfusion (OR 1.42 [95% CI: 1.20-1.70], P < 0.01). POP significantly impacted mortality at 30 days (OR: 4 [1.3-12.4], P = 0.01) and 1 year (OR: 6.8 [2.5-8.4], P < 0.01) and was associated with a longer duration of mechanical ventilation, time to weaning from venoarterial extracorporeal membrane oxygenation and stay in an intensive care unit. Plasma exchanges and intravenous administration of immunoglobulins did not increase the risk of POP.


CONCLUSION
After HTx, preoperative mechanical ventilation and blood transfusion were risk factors for POP and were associated with increased mortality. Enterobacteriaceae and Pseudomonas aeruginosa are the most common pathogens of POP.
['Vidal|Charles|C|0000-0003-0364-3637', 'Pasqualotto|Romain|R|', 'James|Arthur|A|', 'Dureau|Pauline|P|', 'Rasata|Julie|J|', 'Coutance|Guillaume|G|', 'Varnous|Shaida|S|', 'Leprince|Pascal|P|', 'Amour|Julien|J|', 'Bouglé|Adrien|A|']
D000368:Aged D001803:Blood Transfusion D004756:Enterobacteriaceae Infections D015199:Extracorporeal Membrane Oxygenation D005260:Female D016027:Heart Transplantation D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D018410:Pneumonia, Bacterial D011182:Postoperative Care D011183:Postoperative Complications D011237:Predictive Value of Tests D011552:Pseudomonas Infections D012121:Respiration, Artificial D012189:Retrospective Studies D012307:Risk Factors D015300:Ventilator Weaning
Pneumonia Heart transplantation Mechanical ventilation Transfusion Sensitized recipient