Short- and long-term outcomes after heart transplantation in cardiac sarcoidosis and giant-cell myocarditis: a systematic review and meta-analysis

Abstract

Heart transplantation (HTx) is a valid therapeutic option for end-stage heart failure secondary to cardiac sarcoidosis (CS) or giant-cell myocarditis (GCM). However, post-HTx outcomes in patients with inflammatory cardiomyopathy (ICM) have been poorly investigated. We searched PubMed, Scopus, Science Citation Index, EMBASE, and Google Scholar, screened the gray literature, and contacted experts in the field. We included studies comparing post-HTx survival, acute cellular rejection, and disease recurrence in patients with and without ICM. Data were synthesized by a random‐effects meta‐analysis. We screened 11,933 articles, of which 14 were considered eligible. In a pooled analysis, post-HTx survival was higher in CS than non-CS patients after 1 year (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.60–1.17; I2 = 0%) and 5 years (RR 0.72, 95% CI 0.52–0.91; I2 = 0%), but statistically significant only after 5 years. During the first-year post-HTx, the risk of acute cellular rejection was similar for patients with and without CS, but after 5 years, it was lower in those with CS (RR 0.38, 95% CI 0.03–0.72; I2 = 0%). No difference in post-HTx survival was observed between patients with and without GCM after 1 year (RR 1.16, 95% CI 0.05–2.28; I2 = 0%) or 5 years (RR 0.98, 95% CI 0.42–1.54; I2 = 0%). During post-HTx follow-up, recurrence of CS and GCM occurred in 5% and 8% of patients, respectively. Post-HTx outcomes in patients with CS and GCM are comparable with cardiac recipients with other heart failure etiologies. Patients with ICM should not be disqualified from HTx. Graphic abstract

Fulminant Giant Cell Myocarditis following Heterologous Vaccination of ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19

“…Bobbio et al showed that heart transplantation has been the only definitive treatment for advanced GCM, and there was no difference in 1-year survival rates after heart transplantation with and without GCM [ 14 ]. In addition, Kandolin et al showed that repetitive endomyocardial biopsies are required for the diagnosis of GCM, and partial clinical remission is shown in 2/3 of patients with immunosuppression [ 15 ].…”

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

“…Still, often (25.6%) the definitive diagnosis is made after tissue sampling during implantation of a left ventricular assist device or heart transplantation [ 138 ]. A helpful criterion for choosing to perform a biopsy would be the severity of GCM-caused clinical symptoms, coinciding with two of the main recommendations for performing an EMB in the first place [ 1 , 6 , 139 , 140 ].…”

Diagnosis and Treatment of Cardiac Sarcoidosis

“…Recurrence of sarcoidosis in the transplanted heart has been described and may occur in up to 5% of patients. 47 Long-term outcomes, however, are excellent and appear to be similar or better than in the non-CS population. 47,54…”

“…46 These findings are supported by the low relapse rate among heart transplant recipients on life-long immunosuppression. 47 On the other hand, long-term immunosuppression is associated with an important burden of side effects, and many patients may experience worse quality of life (QOL) during the treatment itself. 48 We continue immunosuppression for a minimum of 12 months.…”