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Published on: October 12, 2014
Long-term survival after heart transplantation for cardiac sarcoidosis
Matthew T McGoldrick1, Katherine Giuliano1, Eric W Etchill1
1Department of Surgery, Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Insights
Heart transplants for cardiac sarcoidosis show favorable long-term survival rates, with a reduced risk of mortality compared to other indications. These findings indicate positive outcomes for patients with cardiac sarcoidosis receiving heart transplants.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Cardiac sarcoidosis is an emerging reason for heart transplantation.
- Limited data exists on the long-term prognosis after heart transplant for this condition.
Purpose of the Study:
- To evaluate the long-term outcomes of heart transplantation in patients with cardiac sarcoidosis.
- To compare survival rates and secondary outcomes between cardiac sarcoidosis and other heart transplant indications.
Main Methods:
- Retrospective analysis of adult patients undergoing first-time, single-organ heart transplant.
- Data sourced from the Organ Procurement and Transplantation Network (OPTN) database.
- Study period: January 1999 to March 2020.
Main Results:
- 0.7% of 41,447 heart transplants were for restrictive cardiomyopathy due to cardiac sarcoidosis (RCM-Sarcoidosis).
- RCM-Sarcoidosis patients had a 33% reduced 10-year mortality risk (p=.03) and improved survival (73.4% vs. 59.5%, p=.002).
- No increased risk of graft failure, rejection, or infection; retransplant rates were comparable.
Conclusions:
- Long-term outcomes for heart transplantation due to cardiac sarcoidosis are favorable.
- Cardiac sarcoidosis should be considered a viable indication for heart transplant with good prognosis.
Background:
Cardiac sarcoidosis is an increasingly common indication for a heart transplant, but there is a paucity of knowledge with regard to long-term outcomes following transplant.
Methods:
We utilized the Organ Procurement and Transplantation Network database to retrospectively analyze adult patients undergoing first-time, single-organ heart transplant between January 1999 and March 2020.
Results:
Of the 41,447 patients that underwent heart transplant during the study period, 289 (0.7%) were transplanted for a primary diagnosis of restrictive cardiomyopathy due to cardiac sarcoidosis (RCM-Sarcoidosis). RCM-Sarcoidosis was associated with 33% reduced risk of mortality over 10 years compared to non-RCM indications in a multivariable Cox proportional hazards model (p = .03). Ten-year survival functions were improved among RCM-Sarcoidosis compared to this reference group (73.4% [64.2%-80.6%] vs. 59.5% [58.8%-60.1%], p = .002). Among patients transplanted after 1999 who had at least 10 years of follow-up (n = 19,489), median survival of RCM-Sarcoidosis patients was 11.9 [8.3-14.6] years while that of non-RCM patients was 9.9 [4.0-13.1] years. RCM-Sarcoidosis was not associated with an increased risk of secondary outcomes such as graft failure, rejection, or infection. The incidence of retransplant was comparable between RCM-Sarcoidosis and non-RCM patients (1.38% vs. 1.50%, p = .93).
Conclusions:
These data suggest that long-term outcomes following transplant for cardiac sarcoidosis are favorable compared to heart transplant for other indications.
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