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Published on: April 10, 2019
Clinical outcomes after cardiac transplantation in muscular dystrophy patients
Roland S Wu1, Sachin Gupta, Robert N Brown
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8573, USA.
Insights
Cardiac transplantation may be a safe option for selected muscular dystrophy patients. Outcomes, including survival and complication rates, were similar to those with non-ischemic cardiomyopathy.
Area of Science:
- Cardiology
- Transplantation Medicine
- Neuromuscular Disorders
Background:
- Muscular dystrophy patients are susceptible to dilated cardiomyopathy and advanced heart failure.
- The safety of cardiac transplantation in muscular dystrophy patients remains largely unknown.
Purpose of the Study:
- To evaluate the post-cardiac transplant outcomes in patients with muscular dystrophy.
- To compare these outcomes with a matched cohort of non-muscular dystrophy patients.
Main Methods:
- Retrospective review of the Cardiac Transplant Research Database (1990-2005).
- Compared outcomes of 29 muscular dystrophy patients with 275 non-muscular dystrophy patients (matched controls).
Main Results:
- Survival rates at 1 and 5 years were similar between muscular dystrophy patients and controls (89% vs 91% and 83% vs 78%, respectively).
- No significant differences were observed in cumulative infection, rejection, or allograft vasculopathy rates.
Conclusions:
- Cardiac transplantation appears to yield similar clinical outcomes in selected muscular dystrophy patients compared to age-matched non-ischemic cardiomyopathy patients.
- Limitations include potential selection bias and lack of data on functional capacity.
Background:
Patients with muscular dystrophy are at risk of developing a dilated cardiomyopathy and can progress to advanced heart failure. At present, it is not known whether such patients can safely undergo cardiac transplantation.
Methods:
This was a retrospective review of the Cardiac Transplant Research Database, a multi-institutional registry of 29 transplant centers in the United States, from the years 1990 to 2005. The post-cardiac transplant outcomes of 29 patients with muscular dystrophy were compared with 275 non-muscular dystrophy patients with non-ischemic cardiomyopathy, matched for age, body mass index, gender, and race.
Results:
Becker's muscular dystrophy was present in 52% of the patients. Survival in the muscular dystrophy patients was similar to the controls at 1 year (89% vs 91%; p = 0.5) and at 5 years (83% vs 78%; p = 0.5). The differences in rates of cumulative infection, rejection, or allograft vasculopathy between the 2 groups were not significant (p > 0.5 for all comparisons).
Conclusions:
Recognizing the limitations of the present investigation (ie, selection bias and data lacking in the functional capacity of the muscular dystrophy patients), the current study suggests that the clinical outcomes after cardiac transplantation in selected patients with muscular dystrophy are similar to those seen in age-matched patients with non-ischemic cardiomyopathy.
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