Search

Purpose Infective endocarditis (IE) is a rare but potentially fatal complication following heart transplantation (HTx). There is a lack of literature regarding the patterns and clinical course of IE development following HTx. We sought to pool the existing data in regards to defining characteristics, management options, and outcomes of IE following HTx. Methods An electronic search of Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, and the Scopus databases were performed to identify all articles in the English literature that report IE following HTx in patients greater than 17 years of age. Systematic search yielded 37 patients from 29 articles. Patient-level data were extracted and analyzed. Results Median patient age was 53 [IQR 43, 62] years and 78.4% (29/37) were male. Median time to IE presentation post-HTx was 6.5 [2.6, 16.2] months. IE of the mitral valve was observed in 45.9% (17/37) of patients, followed by mural IE in 24.3% (9/37), and tricuspid valve IE in 24.3% (9/37). The most common organisms were Staphylococcus aureus in 27.0% (10/37), Aspergillus fumigatus in 18.9% (7/37), Enterococcus faecalis in 10.8% (4/37), and an undetermined or unspecified organism in 16.2% (6/37) patients. Aspergillus fumigatus associated mortality occurred in 85.7% (6/7). Surgical management of post-HTx IE was observed in 43.2% (16/37). This included valve surgery for 35.1% (13/37), particularly of the mitral valve in 46.2% (6/13), aortic valve 38.5% (5/13), tricuspid valve 15.4% (2/13), and pulmonic artery graft in 15.4% (2/13). Kaplan-Meier analysis of the survival is shown in the figure. Conclusion In addition to bacterial organisms, Aspergillus fumigatus also represents a frequent cause of IE in post-HTx patients. Overall HTx patient survival after IE occurs is poor, and may be worse with Aspergillus fumigatus IE.