Occurrence and Cost of Infections After Heart Transplant

Occurrence and Cost of Infections After Heart Transplant 1024 683 Mary Bates, PhD
Dr. Emily Hayes

Researchers identify risk factors, long-term outcomes of vaccine-preventable infections following heart transplantation in pediatric patients.

Recently, a study using the Pediatric Health Information System (PHIS) database found that one in six pediatric solid organ transplant recipients were hospitalized with respiratory syncytial virus (RSV) or vaccine-preventable illness in the first five years after transplant. Within this study, heart transplant recipients were at increased risk of hospitalization compared to other organ recipients.

In response to those findings, researchers from Nationwide Children’s Hospital used the PHIS database to determine the risk factors for acquiring these infections and the associated long-term outcomes in pediatric heart transplant recipients. The researchers performed a retrospective cohort study of all pediatric heart transplant recipients with transplant-related hospitalizations available in the PHIS database from September 2003 to December 2018.

“We found that hospitalizations for RSV or vaccine-preventable illness occurred frequently following heart transplantation and were associated with significant cost and hospital resource use,” says Emily Hayes, MD, Pediatric and Adult Advanced Cardiac Therapies Fellow at Nationwide Children’s and one of the study’s authors.

Dr. Hayes and her colleagues found that nearly 18% of pediatric heart transplant patients were hospitalized with RSV or vaccine-preventable illness during the study period, with the majority of hospitalizations occurring within the first five years after transplantation. RSV was the most common infection requiring hospitalization, followed by influenza and pneumococcus.

The median length of stay for a hospitalization for RSV or vaccine-preventable illness in these patients was four days, with a median total cost of more than $11,000.

Surprisingly, the average age of infection for RSV was two years, which is the age at which the American Academy of Pediatrics no longer provides guidance regarding the prophylactic use of palivizumab following heart transplantation.

In addition, induction therapy with two or more immunosuppressants and the need for mechanical circulatory support pre-transplant increased the risk of acquiring RSV or vaccine-preventable illness.

According to Dr. Hayes, the results show that annual vaccinations should be prioritized in this population.

Potential strategies to minimize post-transplant infections include expanding vaccine use through accelerated immunization schedules in younger patients, further studies of the prophylactic use of palivizumab beyond two years of age after transplantation, and routine monitoring of immunogenicity after vaccination with re-immunization based on guidelines.

“This study highlights the importance of vaccinations before and after heart transplantation,” she says. “Primary care physicians, infectious disease consultants, and cardiologists should work together to maximize vaccine opportunities for both patients and their families prior to transplantation.”



Hayes EA, Hart SA, Gowda C, Nandi D. Hospitalizations for respiratory syncytial virus and vaccine preventable infections following pediatric heart transplantation. Journal of Pediatrics. 2021 May 14:S0022-3476(21)00448-0. doi: 10.1016/j.jpeds.2021.05.025. Epub ahead of print.

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.