Purpose: The use of mechanical circulatory assist devices (MCSD) have been increasing over the past several years. Driveline infections (DLI) are one of the most common complications seen in these patients (pts). It has been reported that up to 50% of pts with MCSD may develop DLI. It is believed that the removal of the infected driveline results in treatment of the localized infection area. MCSD pts are also known to develop circulating antibodies (Abs). These circulating Abs have been associated with poor outcome after heart transplantation (HTx). The use of anti-thymocyte globulin (ATG) as induction therapy has been reported to decrease the development of circulating Abs and/or to delay initiation of calcineurin inhibitors in pts with renal dysfunction. It is now commonly used in sensitized pts undergoing HTx. It is not known whether ATG induction therapy immediate post-HTx will increase the risk of infection of those MCSD pts with DLI.

Methods: Between 2003 and 2013 we evaluated 57 MCSD pts who subsequently underwent HTx and received ATG induction therapy. Pts were divided into those with prior MCSD DLI and those without and assessed for 1-year freedom from sternal wound infections. 1-year survival and freedom from treated rejection, both cellular and antibody-mediated, were also assessed.

Results: MCSD pts with DLI who received ATG induction had similar freedom from any-treated infection and sternal wound infection post-HTx compared to those MCSD pts without DLI and not treated with ATG induction. There was also no significant difference between the two groups in terms of 1-year post-HTx survival and freedom from treated rejection (see table).

Conclusion: The use of post-HTx ATG induction in pts with prior DLI does not appear to increase the risk for post-HTx infection (e.g. sternal wound infection). It appears that ATG induction can therefore be used safely in this population.

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