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Cardiac transplantation for cardiomyopathy and ischemic heart disease: differences in outcome up to 10 years
T Aziz1, M Burgess, A N Rahman
1Cardiac Transplant Unit, Wythenshawe Hospital, Manchester, UK. tarekaziz55@hotmail.com
Insights
Heart transplantation outcomes differ significantly between cardiomyopathy (CM) and ischemic heart disease (IHD) patients. Cardiomyopathy recipients show better long-term survival, suggesting alternative treatments for IHD patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Clinical Outcomes Research
Background:
- Ischemic heart disease (IHD) and cardiomyopathy (CM) are leading causes for heart transplantation.
- Understanding differential outcomes is crucial for patient management and resource allocation.
Purpose of the Study:
- To compare the clinical outcomes of heart transplant recipients with IHD versus CM.
- To identify specific differences in post-transplant morbidity and survival between these two patient groups.
Main Methods:
- Retrospective analysis of 133 IHD and 87 CM patients undergoing heart transplantation between 1987-1998.
- Comprehensive follow-up (mean 87 months) assessing operative mortality, complications, and long-term survival.
Main Results:
- CM recipients were younger at transplant (39 vs 51 years) but shared similar donor characteristics and pre-operative hemodynamics.
- IHD recipients had higher rates of peripheral vascular incidents (13% vs 3%) and 10-year coronary artery disease (35% vs 9%).
- Actuarial survival at 10 years was significantly better for CM recipients (80%) compared to IHD recipients (39%).
Conclusions:
- Heart transplantation offers superior medium- and long-term outcomes for cardiomyopathy patients compared to those with ischemic heart disease.
- Given donor organ scarcity, exploring alternative therapies for severe ischemic left ventricular dysfunction is warranted.
Background:
Ischemic heart disease (IHD) and cardiomyopathy (CM) are the most common indications for heart transplantation. The aim of this study was to investigate the difference in clinical outcome between these two groups.
Methods:
At our institution between 1987 and 1998 transplantation was performed in 133 patients with IHD and 87 with CM. Follow-up was complete for all patients (mean 87 months).
Results:
Mean age at time of surgery was 51 +/- 5 years for IHD versus 39 +/- 9 years for CM recipients (p = 0.02). There was no difference in donor age, donor gender, or pre-operative hemodynamics between the two groups. The operative mortality was 11.2% in IHD recipients and 10.6% in CM recipients (p = 0.9). No differences were observed in intra-cardiac pressures or incidence of renal dysfunction, infection, or malignancy between the two groups. The incidence of peripheral vascular incidents was significantly higher for IHD recipients (13% vs 3%, p = 0.02). At 10 years, the incidence of coronary artery disease was 35% and 9%, respectively (p = 0.02). Mean NYHA status was 2.0 +/- 0.3 and 1.1 +/- 0.2 for IHD and CM recipients, respectively (p = 0.013). The actuarial survival at 1, 5, and 10 years was 77%, 62%, and 39% for IHD recipients compared with 85%, 82%, and 80% for CM recipients (p = 0.7, p < 0.0001 and p < 0.0001, respectively).
Conclusion:
After heart transplantation, medium- and long-term outcome is significantly better for CM than IHD recipients. In view of limited donor availability, it is appropriate to explore more vigorously alternative treatments for patients with severe ischemic left ventricular dysfunction.
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