1094 - Infective Endocarditis During Index Hospitalization for Solid Organ Transplantation in the United States

Background: The prevalence and impact of infective endocarditis (IE) on organ transplant recipients is unknown. We used a large cohort of transplant recipients to assess the impact of IE on outcomes during index transplant hospitalization.

Methods: We used data from the 2013-2017 Nationwide Readmissions Database (NRD). Hospitalizations associated with solid organ transplantation procedures (heart, liver, kidney, lung, intestines, pancreas) were included. Outcomes included 60-day rates of mortality, ECMO deployment, thromboembolic events, length of stay, and inpatient costs. For data obtained October 2015 and later, rates of graft rejection and graft failure were also measured.  Regression models, weighted to account for the NRD sample design, were used to model associations between outcomes and transplant procedure, adjusting for patient age, sex, facility characteristics, comorbid conditions, and organs transplanted.

Results: A total of 75,069 hospitalizations for organ transplantation, corresponding to a national estimate of 160,368, were included.  A diagnosis of IE was associated with 416 (weighted estimate = 898). IE cases were less likely to be female (22.2% vs. 37.9%, p< 0.001), and had higher rates of underlying pulmonary disease. The most common organ transplanted in the hospitalization during which IE was diagnosed (allowing for multiple organs) was heart (84.5%) followed by kidney (8.9%) and liver (7.9%), (p< 0.001). IE was associated with higher mortality [adjusted relative risk (aRR): 1.70, 95% confidence interval (CI) (1.09, 2.66)], prolonged ventilation (aRR 1.32 [1.06, 1.65], 4.6 additional inpatient days (CI: 1.5, 7.6) and $28,300 more inpatient cost (CI: $12,000, $44,700) (Table).
 
 60-Day Outcomes, Stratified by IE During Index Transplant Hospitalization


Conclusion: IE complicating hospitalization for organ transplantation is associated with higher rates of morbidity and mortality. IE during index transplant hospitalization occurs most frequently in heart transplant recipients.  Understanding the high rate of IE in heart recipients in the early post-transplant period requires further study.