Introduction
Heart transplantation is considered an important treatment option for
advance heart failure patient who do not respond to medical therapy.
However, before surgery, contraindications for heart transplantation
should be evaluated. These contraindications may include fixed pulmonary
hypertension, active cancer, HIV infection, or active infections with
unstable conditions. [1]
Infection is a significant concern for patients undergoing heart
transplantation include pre- and post-operative period, as it may lead
to the risk of severe infections in these patients. In fact, infections
are the second leading cause of death after graft rejection within the
first 30 days following heart transplantation and the leading cause of
death beyond 30 days post transplantation. [2,3]
Bacterial infections are significant concern for patients undergoing
heart transplantation. According to a study, the incidence of bacterial
infections in these patients can be as high as 43.6%. Common causes of
infection include pneumonia, bloodstream infections due to the placement
of central venous catheters, and infections associated with the use of
ventricular assist devices. In the past, the mortality rate from
invasive pulmonary aspergillosis in heart transplant patients was as
high as 66.7%. However, advancements in medical treatments, including
antifungal medications, adjustment of immunosuppressive therapy, and
improved surgical techniques, have improve survival in these
patients. [4,5]
As a result, current medical guidelines recommend treating fungal
infections until symptoms, radiological findings, and laboratory tests
show improvement before proceeding with heart transplantation. However,
there are no specific recommendations for the optimal duration of
treatment before emergency heart transplantation or in cases where the
patient’s condition requires urgent surgery. [6]