Heart transplantation in muscular dystrophy: Single-center analysis
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Published on: April 10, 2019
Parth Visrodia1, Nikhil J Patel2, Matthew Burford3
1Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Insights
Heart transplantation is a viable option for muscular dystrophy patients with heart failure, despite potential challenges. Specialized multidisciplinary care is crucial for optimizing outcomes in these complex cases.
Area of Science:
- Cardiology
- Neurology
- Transplantation Medicine
Background:
- Muscular dystrophy (MD) frequently involves cardiac complications, potentially leading to end-stage heart failure requiring heart transplantation (HTx).
- Extra-cardiac manifestations in MD, such as pulmonary and skeletal muscle issues, can pose contraindications and complicate post-transplant recovery.
Purpose of the Study:
- To describe the experience and outcomes of heart transplantation in patients with muscular dystrophy at a high-volume center.
- To evaluate the feasibility and survival rates of HTx in MD patients compared to non-MD controls.
Main Methods:
- Retrospective examination of clinical characteristics and outcomes.
- Comparison of 20 MD patients post-HTx with 28 MD patients with heart failure and 40 non-MD HTx controls.
- Matching of control group for age, sex, listing status, and sensitization.
Main Results:
- MD patients undergoing HTx experienced longer ventilator days and hospital stays, with a higher rate of discharge to inpatient rehabilitation.
- Post-transplant, MD patients more frequently required assistive walking devices.
- Survival rates at 1 and 5 years post-HTx were comparable between MD and non-MD groups.
Conclusions:
- Heart transplantation is a feasible treatment for muscular dystrophy patients with advanced heart failure.
- Multidisciplinary specialized care is essential for managing MD-related morbidities and optimizing outcomes after HTx.
Introduction:
Cardiac involvement may occur in many forms of muscular dystrophy (MD). While cardiac disease may progress to warrant heart transplantation (HTx), there may be contraindications related to extra-cardiac disease including pulmonary and skeletal muscle involvement that limit overall survival and impairs post-transplant rehabilitation efforts. This study describes the MD HTx experience at a single high-volume center.
Methods:
We examined the clinical characteristics and outcomes of patients with MD with heart failure (HF) (n = 28), patients with MD status post HTx (n = 20) and non-MD HTx control group (n = 40) matched 2:1 for age at transplant, sex, listing status, and antibody sensitization.
Results:
Patients with MD who underwent HTx had increased ventilator days (2 vs. 1 days, p = .013), increased hospital length of stay (20 vs. 12 days, p = .022), and increased discharge to inpatient rehab (60% vs. 8%, p < .001). By 1 year post HTx, patients with MD more often required assistive devices for walking (55% vs. 10%, p = .01). Nonetheless, post-HTx survival was similar at 1 year (100% vs. 97.5%, p = .48) and 5 years (95.0% vs. 87.5%, p = .36). Of the HTx recipients with MD, 95% were followed by a neurologist, 60% by a neuromuscular specialist as part of the Muscular Dystrophy Association Clinic at our center.
Conclusion:
Transplantation is a feasible option for patients with MD and advanced HF. MD patients who undergo transplantation may benefit from multidisciplinary specialized care to optimize MD-related morbidity.
