Background: Ventricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac\ntransplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant\ninfections in a nationwide cohort of heart transplant recipients.\nMethods: Heart transplant recipients included in the Swiss Transplant Cohort Study between May 2008 and December\n2012 were analyzed. Cumulative incidence curves were used to calculate the incidence of bacterial or Candida\ninfections (primary endpoint) and of other infections (secondary endpoint) after transplant. Cox regression models\ntreating death as a competing risk were used to identify risk factors for the development of infection after transplant.\nResults: Overall, 119 patients were included in the study, 35 with a VAD and 84 without VAD. Cumulative incidences\nof post-transplant bacterial or Candida infections were 37.7 % in VAD patients and 40.4 % in non-VAD patients. In\nmultivariate analysis, the use of cotrimoxazole prophylaxis was the only variable associated with bacterial/Candida\ninfections after transplant (HR 0.29 [95 % CI 0.15-0.57], p < 0.001), but presence of a VAD was not (HR 0.94, [95 % CI\n0.38-2.32], p = 0.89, for continuous-flow devices, and HR 0.45 [0.15 ââ?¬â?? 1.34], p = 0.15, for other devices). Risk for\npost-transplant viral and all fungal infections was not increased in patients with VAD. One-year survival was\n82.9 % (29/35) in the VAD group and 82.1 % (69/84) in the non-VAD group. All 6 patients in the VAD group\nthat died after transplant had a history of pre-transplant VAD infection.\nConclusion: In this nationwide cohort of heart transplant recipients, the presence of VAD at the time of transplant\nhad no influence on the development of post-transplant infections.
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