Recent Trends in Hospitalizations for Infection in the First Year After Heart Transplantation.

Background: Infection is a major cause of morbidity and mortality after heart transplantation (HT). Recent trends in post-HT infection demand further investigation, particularly given effects of the coronavirus disease 2019 (COVID-19) pandemic. Methods: We identified all adult HT recipients in the United States from October 18, 2018, to June 30, 2023, using Organ Procurement and Transplantation Network data. We categorized transplants into 3 eras, accounting for COVID-19: October 2018 to March 2020, March 2020 to March 2022, and after March 2022. Survival was compared using Kaplan-Meier survival analysis and Cox proportional hazards regression. Readmission hospitalizations for infection in the first year after HT were compared using multivariable logistic regression, adjusted for era and donor and recipient characteristics. Results: Of 13,663 patients who received HT (median age, 57 years; 72.9% men), hospitalization for infection in the first year after transplant was 2.9% (n = 3645) for patients who received a transplant in October 2018 to March 2020, 5.4% (n = 5658) for patients who received a transplant in March 2020 to March 2022 and 11.6% (n = 4360) for patients who received a transplant after March 2022 (P < .001). Compared with patients who received a transplant between October 2018 and March 2020, patients who received a transplant during March 2020 to March 2022 (adjusted odds ratio, 1.91; 95% CI, 1.51-2.41) and after March 2022 (adjusted odds ratio, 4.37; 95% CI, 3.30-5.78) eras were more likely to be hospitalized for infection in their first year after HT. After adjusting for covariates, we found no significant difference in the risk of death for recipients who received a transplant from March 2020 to March 2022 (adjusted hazard ratio, 0.86; 95% CI, 0.67-1.11; P = .257) or after March 2022 (adjusted hazard ratio, 1.01; 95% CI, 0.73-1.39, P = .955) compared with March 2018 to March 2020. Conclusions: Odds of hospitalization for infection in the first year after HT performed between March 2020 and March 2022 and after March 2022 were 1.91 and 4.37 times as high, respectively, as HT performed between October 2018 and March 2020.