Abstract
Myocarditis is a known etiology of both acute fulminant heart failure and chronic dilated cardiomyopathy requiring heart transplantation. We sought to evaluate the long-term post-transplant outcomes of pts with myocarditis.
We evaluated the UNOS registry for all heart transplant (HT) recipients from 1987 to 2019. Comparisons between pt characteristics of HT recipients with myocarditis (N=649) and HT recipients without a diagnosis of myocarditis (N=62,493) are reported using standard statistical methods including Cox proportional hazards regression for survival analysis.
Myocarditis HT recipients were younger (29.6 ± 20.7 vs. 46.8 ± 19.1, p<0.001) and more likely to be female (44.1% vs. 26.0%, p<0.001). Myocarditis HT recipients were less likely to be DM (6.6% vs. 20.7%, p<0.001) and to have undergone prior cardiac surgery (7.6% vs. 18.4%, p<0.001). In terms of transplant related factors, myocarditis HT recipients were likely to receive a younger donor (23.3 ± 15.0 vs. 28.3 ± 13.9, p<0.001) and have shorter ischemic times (p<0.001). Prior to transplant, the myocarditis HT recipients were a sicker cohort and more likely to require ECMO [6.0% vs. 1.0%, p<0.001), VAD support (34.4% vs. 25.0%, p<0.001), and MV (13.4% vs. 4.2%, p<0.001). Median (interquartile range) time on the wait list was significantly shorter for myocarditis HT recipients [37.0 (12.0, 100.0) days vs. 83.0 (26.0, 231.0) days, p<0.001]. There was a lower overall post-transplant mortality in the myocarditis HT recipients (26.0% vs. 34.2%, p<0.001).
Myocarditis HT recipients tend to be a younger population with less underlying co-morbidities such as DM and prior cardiac surgery, but they are more likely to be more acutely sick at the time of heart transplantation requiring mechanical ventilation, ECMO, or VAD support. Myocarditis HT recipients have shorter organ wait times and have more favorable transplant related factors, and ultimately have a lower overall mortality compared to recipients without myocarditis.