In 2015 there will be an estimated 11.3 million cancer survivors. With a growing population of cancer survivors, it is imperative to understand treatment options and outcomes for chemotherapy related cardiomyopathy. Anthracycline (AC) based chemotherapy causes heart failure (HF) in approximately 5% of patients. Orthotopic heart transplant (OHT) is an option for cancer survivors in complete remission who develop end-stage HF. We examined retrospective OHT data collected from United Network of Organ Sharing (UNOS) from 1987–2011. The primary aim to was characterize the survival in patients with either the primary diagnosis of “Dilated Cardiomyopathy: Adriamycin” (DCA) versus “all other” causes of cardiomyopathy. The secondary aim was to define the differences in primary cause of death and to describe the temporal relationship of DCA OHT. The UNOS database identified 453 OHT for the diagnosis of DCA and 51,312 OHT for all other causes of cardiomyopathy. DCA group was significantly younger with a higher percentage of females. After adjusting for age, gender, and previous history of malignancy, the 10-year survival curves show that DCA patients have an improved survival over all other causes cardiomyopathy (HR 1.28, p = 0.026). There was no difference in the primary cause of death between the 2 groups. There was a statistically significant increasing temporal trend in the number of OHT for the diagnosis DCA. In conclusion patients who undergo OHT for DCA have a favorable 10-year survival, making OHT a good therapeutic option for end-stage HF due to anthracyclines. Additionally there was no increased risk of cancer related deaths in the DCA, demonstrating that recurrent malignancy does not impact long-term survival. Temporal trends demonstrate that DCA remains a significant problem for cancer survivors.

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Axillary intra-aortic balloon pump therapy provides excellent support for selected patients as a bridge to transplant. The majority of the patients were successfully bridged to transplant and discharged. Although this therapy has been described in previous studies, this is the largest series to incorporate a regimen of aggressive ambulation with daily measurements of distances walked.

Unlike the lung allocation score, currently, there is no quantitative scoring system available for patients on heart transplant waiting list. By using United Network for Organ Sharing (UNOS) data, we aim to generate a scoring system based on the recipient and donor risk factors to predict posttransplant survival. Available UNOS data were queried between 2005 and 2013 for heart transplant recipients aged ≥18 years to create separate cox-proportional hazard models for recipient and donor risk scoring. On the basis of risk scores, recipients were divided into five groups and donors into three groups. Kaplan-Meier curves were used for survival. Total 17,131 patients had heart transplant within specified time period. Major factors within high-risk groups were body mass index > 30 kg/m (46%), mean pulmonary artery pressure >30 mmHg (65%), creatinine > 1.5 mg% (63%), bilirubin > 1.5 mg% (54%), noncontinuous-flow left ventricular assist devices (45%) for recipients and gender mismatch (81%) and ischemia time >4 hours (88%) for donors. Survival in recipient groups 1, 2, 3, 4, and 5 at 5 years was 81, 80, 77, 74, and 62%, respectively, and in donor groups 1, 2, and 3 at 5 years was 79, 77, and 70%, respectively (p < 0.001). Combining donor and recipient groups based on scoring showed acceptable survival in low-risk recipients with high-risk donor (75% at 5 years). A higher recipient and donor risk score are associated with worse long-term survival. A low-risk recipient transplanted with high-risk donor has acceptable survival at 5 years, but high-risk recipient combined with a high-risk donor has marginal results. Using an objective scoring system could help get the best results when utilizing high-risk donors.

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