Invasive fungal infection after heart transplantation: A 7-year, single-center experience

Ignacio A. Echenique, Michael P. Angarone, Robert A. Gordon, Jonathan Rich, Allen S. Anderson, Edwin C. McGee, Travis O. Abicht, Joseph Kang, Valentina Stosor

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Invasive fungal infections (IFIs) are an infrequent but major complication of heart transplantation (HT). We sought to describe the epidemiology at our institution. Methods: A prospective cohort study of 159 heart transplant recipients was performed from June 2005 to December 2012. IFIs were defined by European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Results: By univariate analysis, Hispanic ethnicity was associated with IFI (P=.01, odds ratio [OR] 7.0, 95% confidence interval [CI] 1.7-27.9). Subsequently, a multivariate logistic regression was performed adjusting for Hispanic ethnicity, age, and gender. Seventeen IFIs were identified, occurring at a median 110 days post HT (interquartile range: 32-411 days). Five IFIs (29% of IFIs and 3.1% of all HT) occurred during the HT hospitalization, with 13 IFIs during the first year (incidence 8.2%). Conclusions: The cumulative incidence was 10.7%. IFIs were associated with pre- and post-HT vancomycin-resistant Enterococcus colonization and/or infection, post-HT renal replacement therapy, anti-thymocyte globulin induction, and antibody-mediated rejection. There were no associations with diabetes mellitus, desensitization, 2R/3R cellular rejection, treatments for rejection, re-operation, neutropenia, or cytomegalovirus infection. IFIs were associated with death (P=.02, OR 3.9, 95% CI 1.3-12.1) and 1-year mortality (P<.001, OR 9.0, 95% CI 2.3-35.7), but not 3-year mortality. Associations with Hispanic ethnicity must be validated. Optimal strategies for risk reduction and prophylaxis remain undefined.

Original languageEnglish (US)
Article numbere12650
JournalTransplant Infectious Disease
Issue number1
StatePublished - Feb 1 2017
Externally publishedYes


  • Aspergillosis
  • candidiasis
  • heart transplantation
  • invasive fungal infection

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation


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