DETERMINANTS OF POSTOPERATIVE INFECTIONS AND IMPACT ON PERIOPERATIVE HEART TRANSPLANTATION OUTCOMES

Background and Aim: Outcome of patients undergoing heart transplantation (HTX) can be severely affected by post- operative infections. The present study is aimed at identifying their determinants and at analyse short-term outcomes. Methods: Through a retrospective analysis, adults undergoing HTX at Bologna University Hospital from January 2013 to December 2023 (n=231) were either assigned to group 1 (n=63) or group 2 (n=168), according to a positive or negative postoperative infection history, respectively. Results: Among preoperative recipient characteristics, no significant difference regarding sex, obesity (defined as BMI >30 kg/m 2 ), history of diabetes mellitus and of device or drive-line infection (in patients implanted with VAD) was found. Instead, incidence of postoperative infections was significantly higher in patients undergoing HTX on IABP ( p =0.012), ECMO ( p =0.036), mechanical ventilation ( p =0.041) or with a history of cardiac surgery ( p =0.002). Furthermore, a significant difference in postoperative infection rates was observed among patients requiring postoperative early CRRT ( p <0.001), ECMO ( p =0.001) or surgical revision ( p <0.001). Moreover, patients developing postoperative infections had significantly longer ICU stay ( p <0.001) and hospital stays ( p <0.001). Lastly, 30-day mortality was significantly higher among patients developing postoperative infections ( p =0.037); 1-year mortality was, instead, not affected, with Kaplan-Meier survival analysis showing no significant difference ( p =0.323 log-rank). Conclusions: A critical perioperative state appears linked to a higher rate of postoperative infections, which significantly affect short-term outcomes and length of hospitalization. No significant impact of postoperative infections on 1-year survival was identified.