Comparing outcomes for infiltrative and restrictive cardiomyopathies under the new heart transplant allocation system

Griffin, Jan M.; DeFilippis, Ersilia M.; Rosenblum, Hannah; Topkara, V.K.; Fried, Justin; Uriel, Nir; Takeda, Koji; Farr, Maryjane; Maurer, Mathew S.; Clerkin, Kevin J.

doi:10.1111/ctr.14109

Cited by 15 publications

(7 citation statements)

References 27 publications

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“…Thus, the smaller sample size and the different study design could potentially underpower statistical analyses of interest. 12,13 In conclusion, this analysis of the UNOS Registry showed that short-term and long-term all-cause mortality and rejection risks after isolated HT were not inferior in sarcoid cardiomyopathy as compared with other common types of non-ischaemic cardiomyopathy. These data suggest that HT can be safe and effective in this growing patient population with advanced HF due to CS.…”

Section: Discussionmentioning

confidence: 67%

Outcomes after heart transplantation in patients with cardiac sarcoidosis

et al. 2022

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BackgroundThe number of patients with sarcoidosis requiring heart transplantation (HT) is increasing. The aim of this study was to evaluate outcomes of isolated HT in patients with sarcoid cardiomyopathy and compare them to recipients with non-ischaemic restrictive or dilated cardiomyopathy. Methods and resultsAdult HT recipients were identified in the UNOS Registry between 1990 and 2020. Patients were grouped according to diagnosis. The cumulative incidences for the all-cause mortality and rejection were compared using Fine and Gray model analysis, accounting for re-transplantation as a competing risk. Rejection was evaluated using logistic regression analysis. We also reviewed characteristics and outcomes of all HT recipients with previous diagnosis of sarcoid cardiomyopathy from a single centre. A total of 30 160 HT recipients were included in the present study (n = 239 sarcoidosis, n = 1411 non-ischaemic restrictive cardiomyopathy, and n = 28 510 non-ischaemic dilated cardiomyopathy). During a total of 194 733 patient-years, all-cause mortality at the latest follow-up was not significantly different when comparing sarcoidosis to non-ischaemic dilated cardiomyopathy [adjusted subhazard ratio (aSHR) 1.46, 95% confidence intervals (CIs): 0.9-2.4, P = 0.12] or restrictive cardiomyopathy (aSHR 1.12, 95% CI: 0.65-1.95, P = 0.67). Accordingly, multivariable analysis suggested that 1 year mortality was not significantly different between sarcoidosis and non-ischaemic dilated cardiomyopathy (aSHR 1.56, 95% CI: 0.9-2.7, P = 0.12) or restrictive cardiomyopathy (aSHR 1.15, 95% CI: 0.61-2.18, P = 0.66). No differences were observed regarding 30 day mortality, treated and hospitalized acute rejection, and 30 day death from graft failure after HT. Thirty-day mortality did not improve significantly in more recent HT eras whereas there was a trend towards improved 1 year mortality in the latest HT era (P = 0.06). Data from the single-centre case review showed excellent long-term outcomes with sirolimus-based immunosuppression. Conclusions Short-term and long-term post HT outcomes among patients with sarcoid cardiomyopathy are similar to those with common types of non-ischaemic cardiomyopathy.

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Section: Discussionmentioning

confidence: 67%

Outcomes after heart transplantation in patients with cardiac sarcoidosis

et al. 2022

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“…Patient characteristics at the time of listing were comparable between France and the United States, with more frequent use of balloon pump and inotropic support in the United States as the main exception. 25,26 In the new US system, the proportion of patients undergoing HT with status 1 to 3 is high (70.6%–76.3%), with nearly half of these patients having exception status. 25,26 Restrictive heart disease has been identified as a risk factor for posttransplant mortality.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 In the new US system, the proportion of patients undergoing HT with status 1 to 3 is high (70.6%–76.3%), with nearly half of these patients having exception status. 25,26 Restrictive heart disease has been identified as a risk factor for posttransplant mortality. Recently, the 39th annual International Society for Heart and Lung Transplantation adult HT report, which focused on transplantation for heart disease with restrictive physiology, studied the effect of the restrictive disease type on posttransplant survival.…”

Section: Discussionmentioning

confidence: 99%

Waitlist Outcomes in Candidates With Rare Causes of Heart Failure After Implementation of the 2018 French Heart Allocation Scheme

Legeai,

Coutance,

Cantrelle

et al. 2024

Circ: Heart Failure

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BACKGROUND: In 2018, an algorithm-based allocation system for heart transplantation (HT) was implemented in France. Its effect on access to HT of patients with rare causes of heart failure (HF) has not been assessed. METHODS: In this national study, including adults listed for HT between 2018 and 2020, we analyzed waitlist and posttransplant outcomes of candidates with rare causes of HF (restrictive cardiomyopathy [RCM], hypertrophic cardiomyopathy, and congenital heart disease). The primary end point was death on the waitlist or delisting for clinical deterioration. Secondary end points included access to HT and posttransplant mortality. The cumulative incidence of waitlist mortality estimated with competing risk analysis and incidence of transplantation were compared between diagnosis groups. The association of HF cause with outcomes was determined by Fine-Gray or Cox models. RESULTS: Overall, 1604 candidates were listed for HT. At 1 year postlisting, 175 patients met the primary end point and 1040 underwent HT. Candidates listed for rare causes of HF significantly differed in baseline characteristics and had more frequent score exceptions compared with other cardiomyopathies (31.3%, 32.0%, 36.4%, and 16.7% for patients with hypertrophic cardiomyopathy, RCM, congenital heart disease, and other cardiomyopathies). The cumulative incidence of death on the waitlist and probability of HT were similar between diagnosis groups ( P =0.17 and 0.40, respectively). The adjusted risk of death or delisting for clinical deterioration did not significantly differ between candidates with rare and common causes of HF (subdistribution hazard ratio (HR): hypertrophic cardiomyopathy, 0.51 [95% CI, 0.19–1.38]; P =0.18; RCM, 1.04 [95% CI, 0.42–2.58]; P =0.94; congenital heart disease, 1.82 [95% CI, 0.78–4.26]; P =0.17). Similarly, the access to HT did not significantly differ between causes of HF (hypertrophic cardiomyopathy: HR, 1.18 [95% CI, 0.92–1.51]; P =0.19; RCM: HR, 1.19 [95% CI, 0.90–1.58]; P =0.23; congenital heart disease: HR, 0.76 [95% CI, 0.53–1.09]; P =0.14). RCM was an independent risk factor for 1-year posttransplant mortality (HR, 2.12 [95% CI, 1.06–4.24]; P =0.03). CONCLUSIONS: Our study shows equitable waitlist outcomes among HT candidates whatever the indication for transplantation with the new French allocation scheme.

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“…Similarly, US candidates with HCM and RCM had shorter waitlist time and lower waitlist mortality/delisting, although utilization of temporary MCS and ischemic time increased. 13,14 It is not surprising that RCM experienced higher mortality after transplant in the United States and France, given its frequent association with systemic diseases such as amyloidosis or sarcoidosis or prior radiation exposure. 15 The current analysis does not shed additional light on this finding.…”

Section: See Article By Legeai Et Almentioning

confidence: 99%