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Published on: August 2, 2024
Graft survival after cardiac transplantation for alcohol cardiomyopathy
D Marshall Brinkley1, Eric Novak, Veli K Topkara
11 Division of Cardiovascular Disease, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 2 Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 3 Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY. 4 Address correspondence to: D. Marshall Brinkley, M.D., Division of Cardiovascular Disease, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, West Campus, Baker 4, Boston, MA 02215.
Insights
Alcohol cardiomyopathy (ACM) patients had worse survival post-transplant, but ACM itself was not linked to graft survival. Other recipient factors influenced outcomes in this cardiac transplant study.
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health
Background:
- Alcohol cardiomyopathy (ACM) accounts for a significant portion of non-ischemic dilated cardiomyopathy.
- Continued alcohol exposure worsens transplant-free survival in ACM patients compared to idiopathic dilated cardiomyopathy (IDCM).
- Prognosis of ACM patients post-cardiac transplantation remains unclear.
Purpose of the Study:
- To investigate the prognosis of patients with alcohol cardiomyopathy (ACM) after cardiac transplantation.
- To compare graft survival and other outcomes between ACM and idiopathic dilated cardiomyopathy (IDCM) cohorts.
Main Methods:
- Analysis of adult cardiac transplant recipients from 1994-2009 using the Organ Procurement Transplantation Network registry.
- Inclusion of 134 ACM patients and 10,243 IDCM patients.
- Kaplan-Meier curves and Cox proportional hazards models to assess graft failure, cardiac allograft vasculopathy, and rejection hospitalization.
Main Results:
- ACM patients were more likely to be male, minorities, and smokers.
- The ACM cohort showed lower overall graft survival.
- Multivariate analysis indicated ACM was not an independent predictor of graft survival, though factors like creatinine and donor age were significant.
Conclusions:
- Alcohol cardiomyopathy (ACM) is not independently associated with graft survival after cardiac transplantation.
- Poorer overall survival in ACM recipients is linked to other recipient characteristics, not the cardiomyopathy type itself.
Background:
Alcohol cardiomyopathy (ACM) constitutes up to 40% of patients with non-ischemic dilated cardiomyopathy. Transplant-free survival is worse for patients with ACM versus idiopathic dilated cardiomyopathy (IDCM) with continued exposure. The prognosis for patients with ACM after cardiac transplantation is unknown.
Methods:
We evaluated adults who underwent single-organ, cardiac transplantation from 1994 to 2009 with a diagnosis of ACM (n=134) or IDCM (n=10,243) in the Organ Procurement Transplantation Network registry. Kaplan-Meier curves were generated by cohort for time until graft failure, cardiac allograft vasculopathy, and hospitalization for rejection. A Cox proportional hazards model was created to determine factors associated with each outcome.
Results:
Patients with ACM were more likely to be males (P<0.0001), minorities (P<0.0001), and smokers (P=0.0310) compared with IDCM. Overall graft survival was lower for the ACM cohort (P=0.0001). After multivariate analysis, ACM was not independently associated with graft survival (HR 1.341, 95% CI 0.944-1.906, P=0.1017). Creatinine, total bilirubin, minority ethnicity, graft under-sizing, life support, diabetes, and donor age were independent predictors of graft failure. There were no significant differences between primary cause of death, vasculopathy, or rejection.
Conclusions:
There was no association between ACM and graft survival in this large registry study, but poorer overall survival in the ACM cohort was associated with other recipient characteristics.
