UNOS Registry Myocarditis Heart Transplantation Outcome

J. P. Li¹, P. Kingsford¹, S. Nuno¹, D. Miklin¹, G. Liu², J. Rahman², K. Pandya², C. Lum³, P. Banankhah², P. Genyk¹, D. Vucicevic⁴, A. Wolfson⁵, R. Chand⁶, K. Yang¹, S. Shah¹, A. Kiankhooy⁷, J. Nattiv², S. Hashmi¹, J. Pizula¹, A. Lee¹, M. Fong², L. Grazette², E. C. DePasquale², A. S. Vaidya²

¹Internal Medicine, Keck Medicine of USC, Los Angeles, CA, ²Cardiology, Keck Medicine of USC, Los Angeles, CA, ³Internal Medicine, The Queen's Medical Center, Honolulu, HI, ⁴Cardiology, Newark Beth-Israel Medical Center, Newark, NJ, ⁵Cardiology, University of Arizona Sarver Heart Center, Tuscon, AZ, ⁶Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA, ⁷Cardiothoracic Surgery, Keck Medicine of USC, Los Angeles, CA

Meeting: 2020 American Transplant Congress

Abstract number: B-271

Keywords: Heart, Heart failure, Heart transplant patients, Hemodynamics

Topic:

Session Information

Session Name: Poster Session B: Heart and VADs: All Topics

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Hospitalized myocarditis patients have a variable course that can require heart transplantation at a rate of about 3-4%. We sought to evaluate the post-transplant outcomes of myocarditis patients.

*Methods: After searching the UNOS registry for heart transplant (HT) recipients from 1987 to 2019, comparisons were made between the myocarditis HT recipients (n=649) and the non-myocarditis HT recipients (n=62,493). The analysis included standard statistical methods and Cox proportional hazards regression for survival. Exclusions include age <18 y, follow-up loss, and multi-organ transplant.

*Results: Myocarditis HT recipients were younger (29.6 yo ± 20.7 vs. 46.8 yo ± 19.1, p<0.01) and more likely to be female (44.1% vs. 26.0%, p<0.01). Myocarditis HT recipients were less likely to have DM (6.6% vs. 20.7%, p<0.01) and to smoke (10.6% vs 33.3%, p<0.01). In terms of transplant factors, myocarditis HT recipients were likely to receive a younger donor (23.3 yo ± 15.0 vs. 28.3 yo ± 13.9, p<0.01). Prior to transplant, the myocarditis HT recipients are more likely to require dialysis (3.2% vs 1.6%, p<0.01), ECMO (6.0% vs. 1.0%, p<0.01), VAD support (34.4% vs. 25.0%, p<0.01), and mechanical ventilation (13.4% vs. 4.2%, p<0.01); however, myocarditis patients did not differ in IABP usage. In terms of hemodynamics, myocarditis HT recipients had lower mPAP (25.5 mmHg ± 10.0 vs 28.2 mmHg ± 10.5, p<0.01) and cardiac output (3.9 ± 1.7 L/min vs 4.4 ± 1.5 L/min, p<0.01) but similar wedge pressures. Median (interquartile range) time on the waitlist was significantly shorter for myocarditis HT recipients [37.0 (12.0, 100.0) days vs. 83.0 (26.0, 231.0) days, p<0.01]. There was a lower post-transplant mortality in myocarditis HT recipients (45.1% vs. 50.4%, p<0.01).

*Conclusions: Myocarditis HT recipients tend to be younger, female, with lower rates of DM and smoking, but had higher rates of dialysis and higher utilization of MV, ECMO, or VAD support. Their hemodynamics are notable for lower CO and mPAP. Myocarditis HT recipients have shorter organ wait times and younger donors, which help contribute to a lower mortality compared to recipients without myocarditis.

To cite this abstract in AMA style:

Li JP, Kingsford P, Nuno S, Miklin D, Liu G, Rahman J, Pandya K, Lum C, Banankhah P, Genyk P, Vucicevic D, Wolfson A, Chand R, Yang K, Shah S, Kiankhooy A, Nattiv J, Hashmi S, Pizula J, Lee A, Fong M, Grazette L, DePasquale EC, Vaidya AS. UNOS Registry Myocarditis Heart Transplantation Outcome [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/unos-registry-myocarditis-heart-transplantation-outcome/. Accessed September 25, 2021.

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