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Title: Rejection Therapy After Heart Transplantation Does Not Increase Infectious Risk in Patients Receiving Aggressive Antimicrobial Prophylaxis: Presented at ATC
URL: http://www.pslgroup.com/dg/222D46.htm
Doctor's Guide
June 3, 2008

By Thomas S. May

TORONTO -- June 3, 2008 -- Rejection prophylaxis therapy does not increase the risk of infection in heart transplant patients if they had been receiving aggressive antibiotic prophylaxis, according to research presented here at 2008 American Transplant Congress (ATC).

Lead author Michelle M. Kittleson, MD, PhD, University of California at Los Angeles School of Medicine, Los Angeles, California, presented the findings during a poster session on May 31.

"Our research is significant in that it describes the risk of opportunistic infections in patients who are treated for rejection," Dr. Kittleson said. "This is a common problem after heart transplantation, where patients are at risk for both infection due to heightened immunosuppression and rejection due to inadequate immunosuppression. And the goal is to balance the two risks," she explained.

The retrospective study involved a chart review of 649 patients who had received heart transplants between 1994 and 2006. All patients received aggressive antimicrobial prophylaxis, including valgancyclovir, clotrimoxazole, and trimethoprim/sulfamethoxazole, for 1 year after transplantation.

Out of 67 patients who developed infections (caused by aspergillus, candida, herpes, pneumocystis, cryptococcus, or cytomegalovirus) during the first year, 11 (16%) had been treated for rejection within 1 month prior to the infectious episode. The other 56 (84%) who developed first-year infections had not received rejection therapy in the prior month.

The investigators also noted that only 11 (12%) of a total of 89 patients who were given rejection treatment in the first year developed infectious complications.

"Our study indicates that, even after heightened immunosuppressive therapy to treat rejection, there is no increase in the risk of infection," Dr. Kittleson said.

"This is reassuring for clinicians who are faced with rejection episodes and may be uncomfortable increasing the level of immunosuppression due to [a fear of] an increased risk of infection," she added. "These clinicians can feel more comfortable doing so, since antimicrobial prophylaxis appears to be effective," Dr. Kittleson concluded.


[Presentation title: Aggressive Antimicrobial Prophylaxis Decreases Infectious Risk Despite Rejection Therapy After Heart Transplantation. Abstract 631]

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