Today, transplant recipients are older, sicker and have more co-morbidities than in earlier eras. The aim of this analysis was to evaluate incidence, risk factors and outcome after sternal-wound complications in a current heart transplant cohort
A retrospective analysis was performed in 534 heart patients, transplanted between 1998-2011. Complications were defined according to tissue involvement and presence of infection. Therapy was defined as conservative or surgical. Risk factor analysis was performed to evaluate previously published variables. Survival was compared between patients with vs. without wound complications by Kaplan Meier analysis.
26 (4.9%) patients developed sternal wound complications. 15.4% of cases were non-infectious complications, whereas 61.5% were bacterial and 23.1% were fungal infections. Tissues involved were skin/subcutaneous (61.5%), deep soft tissue (15.4%) or sternum/retrosternal space (23.1%). Median time to bacterial and non-infectious complication infection was shorter than in fungal infections (24 vs. 110 days). Conservative therapy was used in 3 cases (11.5%) whereas surgical therapy was used in 23 (88.5%). In 17 patients (77%) vacuum assisted closure therapy was used and in 6 patients (23%) surgical debridement was performed. We identified 6 significant risk factors (p<005): transfusion requirement post transplantation (12.9% vs. 2.8%), preoperative status (stable 3.3% vs. hospitalised 2.15% vs. inotropic support 8.9% vs. assist device 10.8%), primary graft dysfunction (9.3% vs. 3.9%), body mass index ≥ 30 (14.3% vs. 4.2%), and preoperative intubation (28.6 % vs. 4.6%). 6 & 12 month survival of patients with infection was significantly lower in patients (6-month: 74.1% vs 86%; 12-month: 66.4% vs. 84.5%; p<0.01).
Sternal wound complications have not increased over time. Pre-transplant and peri-operative risk factors are associated with increased incidence. Wound infections are associated with decreased survival after transplantation.
To cite this abstract in AMA style:Groemmer M, Aliabadi A, Salameh O, Kohl M, Wiedemann D, Paljakka O, Laufer G, Zuckermann A. Pus Bonum Et Laudabile? – Wound Healing Complications after Heart Transplantation in the 21st Century [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/pus-bonum-et-laudabile-wound-healing-complications-after-heart-transplantation-in-the-21st-century/. Accessed October 30, 2020.
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