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Biomedical subjects

Jesús Palomo

Publications and source records attributed to Jesús Palomo.

7 recordsLinked to original sources
PubMed2006

Bloodstream infections among heart transplant recipients.

BACKGROUND: Heart transplant (HT) recipients are prone to life-threatening infections, including bloodstream infection (BSI), but information on this topic is particularly scarce. METHODS: We studied 309 consecutive HT performed at our institution between 1988 and 2003. We assessed the characteristics of each episode of BSI, prophylaxis and immunosuppression used, and possible related factors. RESULTS: Sixty episodes of BSI occurred in 15.8% of all HT recipients. Rates of BSI/transplanted patient decreased progressively throughout the study period: 21.2%, 14.3%, and 7.5% in each 5-year period (P=0.03). BSI episodes occurred a median of 51 days after transplantation. The main BSI origins were: lower respiratory tract (23%), urinary tract (20%), and catheter-related-BSI (16%). Gram-negative organisms predominated (55.3%), followed by Gram-positive (44.6%). Mortality was 59.2%, with 12.2% directly attributable to BSI. Independent risk factors for BSI after HT were: hemodialysis (OR 6.5; 95% CI 3.2-13), prolonged intensive care unit stay (OR 3.6; 95% CI 1.6-8.1), and viral infection (OR 2.1; 95% CI 1.1-4). BSI was a risk factor for mortality (OR 1.8; 95% CI 1.2-2.8). CONCLUSION: BSIs have decreased in HT recipients, but still contribute to mortality, mainly if related to pneumonia or polymicrobial infections. Reduction of early postoperative complications and viral infections are amenable goals that may further reduce BSI in this population.

Bacteremia↗
PubMed2005

[Prognosis of heart transplant candidates stabilized on medical therapy].

INTRODUCTION AND OBJECTIVES: A significant percentage of patients selected as candidates for heart transplantation can be stabilized by medical treatment, thereby enabling indefinite postponement of inclusion on the operation list. The aim of this study was to investigate the prognosis of these patients. PATIENTS AND METHOD: We studied retrospectively 118 patients with severe left ventricular systolic dysfunction (ejection fraction < or = 35%) who were consecutively evaluated for cardiac transplantation but who did not undergo transplantation because they became clinically stable on medical treatment. The mean follow-up period was 2.14 (2.19) years. Kaplan-Meier survival analysis, and univariate and multivariate Cox proportional risk analyses of factors predicting survival were performed. RESULTS: There were 18 deaths (15.2%): 12 were sudden (66.7%), 5 were due to heart failure (27.8%), and 1, to a non-cardiac cause (5.5%). The survival rate was 88% in the first year and 82% in the following 2 years. Univariate analysis showed that the parameters associated with mortality (P< or =.05) were pulmonary artery and capillary wedge pressures, diuretic treatment, and the absence of beta-blocker therapy. In the multivariate analysis, only the absence of beta-blocker therapy remained statistically significant (P=.003; RR = 0.13; 95%CI, 0.03-0.50). CONCLUSIONS: In a population of patients with severe left ventricular systolic dysfunction who were candidates for heart transplantation but who were stabilized by medical therapy, mortality during the first year of follow-up was 12%. Beta-blocker therapy was the only variable associated with better survival.

Algorithms↗
PubMed2004

Risk factors of invasive aspergillosis after heart transplantation: protective role of oral itraconazole prophylaxis.

The study was designed to identify a subset of heart transplant (HT) recipients who could benefit from the administration of targeted antifungal prophylaxis and to evaluate the efficacy of oral itraconazole as the preventive drug. We have analyzed the risk factors for invasive aspergillosis (IA) in our entire population of HT recipients (1988-2002) and also the role of oral itraconazole prophylaxis that was provided to all patients since 1995 [400 mg q.d. of itraconazole oral (PO) for 3-6 months]. There were 24 cases of IA. Our main results indicate that the independent risk factors for IA after heart transplantation are: re-operation (RR 5.8; 95% CI 1.8-18, p=0.002), cytomegalovirus (CMV) disease (RR 5.2; 95% CI 2-13.9, p=0.001), post-transplant hemodialysis (RR 4.9; 95% CI 1.2-18, p=0.02), and the existence of an episode of IA in the HT program 2 months before or after the transplantation date (RR 4.6; 95% CI 1.5-14.4, p=0.007). Itraconazole prophylaxis showed an independent protective value against developing IA (RR 0.2; 95% CI 0.07-0.9, p=0.03) and also determined a significantly prolonged 1-year survival (RR 0.5; 95% CI 0.3-0.8, p=0.01). We believe that antifungal prophylaxis in heart transplant patients should be offered at least to patients with one or more of these predisposing conditions.

Administration, Oral↗
PubMed2003

The isolation of Aspergillus fumigatus from respiratory tract specimens in heart transplant recipients is highly predictive of invasive aspergillosis.

BACKGROUND: Prompt recognition of invasive pulmonary aspergillosis (IPA) after heart transplantation is essential for achieving a successful outcome. However, the significance of the isolation of from respiratory specimens in heart transplant recipients is not established. METHODS: From 1990 to 1999, we analyzed first respiratory specimens with spp. growth from heart transplant patients in our institution. All specimens were cultured in both fungal and conventional media. Diagnosis of proven and probable IPA or colonization was made according to criteria of the Mycoses Study Group. RESULTS: During the 10-year study period, spp. was recovered from 30 episodes from 27 heart transplant recipients (incidence: 10.5%). Three episodes were classified as indeterminate and were included in the analysis in a double way, first considering them as true positives and afterward as true negatives, so ranges were obtained. After applying diagnostic criteria, 18 of 30 episodes were proven or probable IPA, and 9 episodes were colonizations. Accordingly, 7 to 8% of heart transplant recipients suffered an IPA, and the overall positive predictive value (PPV) was 60% to 70%. When analyzed by species, the PPV of recovering was 78% to 91%, whereas it was 0% for other species. The PPV increased to 88% to 100% when was recovered from a respiratory specimen other than sputum and decreased to 50% to 67% when it was recovered from sputum. The sensitivities of fungal and conventional media for the recovery of spp. were 95% to 100% and 33% to 38%, respectively. CONCLUSION: The isolation of from the respiratory tract of a heart transplant recipient is highly predictive of invasive aspergillosis.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed2002

[Giant cell myocarditis. A case report].

Giant cell myocarditis is a rare disease of unknown origin that is probably autoimmune in nature; the prognosis is poor and death often ensues unless a heart transplant is performed. Several cases responding to immunosuppressive therapy have been recently reported, however. We describe a patient who developed fulminant heart failure requiring heart transplantation. Examination of the explanted heart confirmed the diagnosis of giant cell myocarditis.

Heart Transplantation↗