Incidence and Risk Factors for Infection in Heart Transplant Recipients on Posttransplant Extracorporeal Membrane Oxygenation (ECMO)

Background: The use of extracorporeal membrane oxygenation (ECMO) after transplantation seems to be associated with an increased risk for infectious complications. We assessed the impact of ECMO use on the incidence of infectious diseases in a nationwide cohort of heart transplant recipients. Methods: Patients undergoing heart transplantation between 2008 and 2017 and enrolled in the Swiss Transplant Cohort Study were included. We calculated incidence rates of infection at 1-y posttransplant and used Cox regression to identify infection-associated risk factors according to the pathogen group. Results: We included 306 heart transplant recipients of whom 42 patients (13.7%) received ECMO in the posttransplant period. Incidence rates at 1 y for overall infection were 259 per 100 patient-years in the ECMO group (176 for bacterial, 52 for viral and 36 for fungal infections) and 126 per 100 patient-years in the non-ECMO group (68 for bacterial, 45 for viral and 14 for fungal infections). In the ECMO group, gram-negative bacterial infections predominated over gram-positive pathogens. Use of ECMO was associated with an increased risk of overall infections (hazard ratio 1.81 [95% CI. 1.02-3.19], = 0.04) and fungal infections (hazard ratio 3.44 [95% CI, 1.33-8.89], = 0.01). Conclusions: In this nationwide cohort of heart transplant recipients, the use of ECMO was associated with an increased risk for overall and fungal infections. More studies are needed to evaluate whether ECMO is independently associated with infection or a surrogate for a more critical patient condition.