Changes in bloodstream infections in heart transplant recipients following the allocation guidelines change

IF 8.1 2区医学 Q1 SURGERY

American Journal of Transplantation Pub Date : 2026-10-01 Epub Date: 2026-05-26 DOI:10.1016/j.ajt.2026.05.2294

Alyssa K. Mezochow, Marcus R. Pereira, Juan Ortega-Legaspi, Thresiamma Lukose, Warren B. Bilker, Teresa Wang, Pam Tolomeo, Jacqueline Omorogbe, Olaoluwa Olaiya, Zane Bekheet, John Janosevic, Ebbing Lautenbach

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引用次数: 0

Abstract

In 2018, the orthotopic heart transplant (OHT) allocation policy in the United States changed to prioritize more critically ill candidates, including those supported with temporary mechanical circulatory support (tMCS). This study evaluated changes in posttransplant bloodstream infection (BSI) rates following the OHT allocation change. We conducted a retrospective cohort study of OHT recipients at 2 large United States transplant centers from January 1, 2015, to December 31, 2022. Recipients were followed 90 days post-OHT for BSIs. The association between policy era and BSIs was evaluated using multivariable Cox regression with mediation analysis to explore the effect of tMCS. There were 895 OHT recipients with a nearly two-fold increase in pretransplant tMCS after the policy change. Seventy-nine recipients developed BSIs (8.8%). OHT in the postpolicy era was associated with a 1.9-fold increased hazard of BSI (P = 0.018). Mediation analysis showed tMCS acted as a significant mediator of increased BSI risk after the change. One-year mortality and graft failure were similar across the 2 policy eras, although there was a significant decrease in 1-year rejection following the change (P < .001). Overall, post-OHT BSI risk nearly doubled following the allocation change, which is mediated by tMCS. Additional studies are needed to further investigate factors contributing to BSI risk.

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心脏移植受者血流感染在分配指南改变后的变化

2018年，美国的原位心脏移植（OHT）分配政策发生了变化，优先考虑更多危重患者，包括临时机械循环支持（tMCS）的患者。本研究评估了OHT分配改变后移植后血流感染（BSI）率的变化。我们在2015年1月1日至2022年12月31日期间对美国两家大型移植中心的OHT受体进行了回顾性队列研究。接受者在oht后90天接受BSI随访。采用多变量Cox回归和中介分析来评估政策时代与BSI之间的关系，以探讨tMCS的影响。政策改变后，895名OHT受者移植前tMCS增加了2.5倍。95名受助人发生脑损伤（10.6%）。后政策时代的OHT与BSI风险增加2.3倍相关（P=0.002）。中介分析显示，tMCS解释了改变后BSI风险增加的部分原因，但不是全部原因。在这两个政策时期，一年的死亡率和移植失败相似，尽管在政策改变后一年的排斥反应显著减少(P

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来源期刊

American Journal of Transplantation 医学-外科

CiteScore

18.70

自引率

4.50%

发文量

346

审稿时长

26 days

期刊介绍： The American Journal of Transplantation is a leading journal in the field of transplantation. It serves as a forum for debate and reassessment, an agent of change, and a major platform for promoting understanding, improving results, and advancing science. Published monthly, it provides an essential resource for researchers and clinicians worldwide. The journal publishes original articles, case reports, invited reviews, letters to the editor, critical reviews, news features, consensus documents, and guidelines over 12 issues a year. It covers all major subject areas in transplantation, including thoracic (heart, lung), abdominal (kidney, liver, pancreas, islets), tissue and stem cell transplantation, organ and tissue donation and preservation, tissue injury, repair, inflammation, and aging, histocompatibility, drugs and pharmacology, graft survival, and prevention of graft dysfunction and failure. It also explores ethical and social issues in the field.