心臓移植後の感染症　概論

抄録

According to the ISHLT registry, the survival outcome of heart transplantation recipients is ever improving. Infection, however, is still a serious complication after heart transplantation, even if a new antibiotic has been developed and viral infection or fungal infection is being treated safely. As the recipients of heart transplant receive immunosuppressive therapy, the frequency of infection varies based on the difference in immunosuppressive agents. These patients are susceptible to infection caused by true pathogens, which are able to overwhelm the natural defense mechanisms of a non immunocompromised host, and non-pathogens which do not present a risk to a normal host, but to which immunocompromised patients are susceptible. While symptomatic infection is a significant cause of morbidity and mortality, surprisingly, even asymptomatic infections are independent risk factors for overall mortality and reduced survival. Infection with cytomegalovirus has been implicated in cardiac graft vasculopathy and Epstein-Barr virus infection is associated with malignant disease. Post-transplant infection is expected to decrease by improvement of infection control and immunosuppressive agents; conversely, ventricular assist devices are a recent option for patients with heart failure awaiting cardiac transplantation, and some studies reported that pre-transplant ventricular assist device infection correlated with a high incidence of bacteremia following heart transplantation and decreased survival. There is concern that it will become a further problem in the near future.