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Outcomes in Patients With Hypertrophic Cardiomyopathy Awaiting Heart Transplantation

Julio Zuñiga Cisneros1, Josef Stehlik1, Craig H Selzman1

  • 1From the Universidad de Panama (J.Z.C.); Hypertrophic Cardiomyopathy Program, University of Utah Health Science Center, Salt Lake City (J.S., C.H.S., S.G.D., S.H.M., O.W.-P.); George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (J.S., C.H.S., S.G.D., S.H.M., O.W.-P.); and Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (J.S., C.H.S., S.G.D., S.H.M., O.W.-P.).

Circulation. Heart Failure
|April 18, 2018
PubMed

Insights

Heart transplant (HT) candidates with hypertrophic cardiomyopathy (HCM) face increasing waitlist mortality despite excellent post-transplant survival. New organ allocation strategies are needed for HCM patients awaiting HT.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Policy

Background:

  • Current heart transplant (HT) allocation policies and mechanical support advancements favor candidates on left ventricular assist devices (LVADs).
  • Hypertrophic cardiomyopathy (HCM) patients are often ineligible for LVADs, potentially disadvantaging them compared to dilated cardiomyopathy patients.
  • The proportion of HCM patients listed for HT has significantly increased.

Purpose of the Study:

  • To compare outcomes of adult HT candidates with HCM to those with ischemic cardiomyopathy (ICM) and non-ICM.
  • To evaluate the impact of mechanical support advancements on waitlist and post-transplant outcomes in HCM patients.
  • To identify potential disparities in the organ allocation system for HCM patients.

Main Methods:

  • Analysis of adult HT candidates from the Scientific Registry of Transplant Recipients (1999-2016).
  • Comparison of HCM patients with ICM and non-ICM cohorts across two eras defined by LVAD approval (pre-2008 and post-2008).
  • Evaluation of waitlist mortality, HT rates, and post-transplant survival.

Main Results:

  • Waitlist mortality for HCM patients showed minimal decline (11.7% to 9.6%) compared to ICM and non-ICM patients across eras.
  • In the later era, 12-month HT rates were comparable across HCM, ICM, and non-ICM groups (approx. 60-65%).
  • Post-transplant survival for HCM patients was notably favorable, particularly in the most recent era (1-year: 91.6%, 5-year: 82.5%).

Conclusions:

  • Despite excellent post-transplant outcomes, HCM patients experience substantial and persistent waitlist mortality.
  • The organ allocation system may not adequately address the needs of increasing HCM candidates for HT.
  • Revised strategies are required to improve organ allocation efficiency and reduce waitlist mortality for hypertrophic cardiomyopathy patients.
Abstract

Keywords:
adultcardiomyopathiesheart transplantationheart-assist deviceshypertrophic cardiomyopathy

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