Heart Transplantation for Giant Cell Myocarditis: A Case Series.

Area of Science:

• Cardiology
• Transplantation Immunology
• Immunosuppression Therapy

Background:

• Giant cell myocarditis (GCM) presents a significant challenge with a poor prognosis without heart transplantation.
• Limited data exists on long-term survival outcomes following heart transplantation for GCM.

Purpose of the Study:

• To evaluate the post-transplant survival rates of patients who underwent heart transplantation for histologically confirmed GCM.
• To analyze the efficacy of perioperative and maintenance immunosuppressive regimens in GCM patients.

Main Methods:

• Retrospective analysis of seven patients with GCM undergoing heart transplantation.
• Utilized perioperative rabbit antithymocyte globulin (rATG), intravenous immunoglobulin, and early initiation of triple immunosuppressive therapy (tacrolimus, mycophenolate, prednisone).

Main Results:

• Six out of seven patients (86%) survived at a median of 842 days post-transplant.
• One patient experienced asymptomatic GCM recurrence at 3 months, successfully managed with increased immunosuppression.
• No patients experienced high-grade rejection episodes.

Conclusions:

• Heart transplantation provides excellent survival for GCM patients when combined with rATG and triple immunosuppressive therapy.
• Patients with GCM remain at risk for recurrence post-transplant, necessitating vigilant monitoring and potential augmentation of immunosuppression.