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Published on: May 8, 2020
Waitlist and post-transplant outcomes for children with myocarditis listed for heart transplantation over 3 decades
Shahnawaz Amdani1, Alfred-Asante Korang2, Yuk Law3
1Department of Pediatric Cardiology, Cleveland Clinic Children's, Ohio.
Insights
Outcomes for pediatric heart transplant recipients with myocarditis are worse than those with dilated cardiomyopathy and have not improved over 30 years. Further research is needed to enhance survival rates for children with myocarditis undergoing heart transplantation.
Area of Science:
- Pediatric Cardiology
- Transplant Immunology
- Critical Care Medicine
Background:
- Limited and conflicting data exist regarding waitlist and transplant outcomes for pediatric myocarditis.
- Myocarditis is a significant cause of heart failure in children requiring heart transplantation.
- Comparing outcomes between myocarditis and dilated cardiomyopathy (DCM) is crucial for understanding disease-specific challenges.
Purpose of the Study:
- To evaluate and compare waitlist and post-heart transplant (HT) outcomes for children with myocarditis versus DCM.
- To assess trends in outcomes for pediatric myocarditis patients over three decades.
- To identify risk factors for adverse outcomes in pediatric heart transplant recipients with myocarditis.
Main Methods:
- Retrospective review of the Pediatric Heart Transplant Society database (1993-2019).
- Inclusion of children with myocarditis and DCM listed for HT.
- Comparison of clinical characteristics, waitlist, and post-HT outcomes between myocarditis and DCM cohorts, and across early (1993-2008) and current (2009-2019) eras.
Main Results:
- Children with myocarditis were more likely to be listed at higher urgency and require intensive support (ICU, mechanical ventilation, ECMO, VAD) compared to DCM.
- While unadjusted analysis showed lower transplant rates and higher waitlist mortality for myocarditis, multivariable analysis did not identify myocarditis as a risk factor for waitlist mortality.
- Myocarditis was a significant risk factor for early graft loss post-HT, and outcomes for myocarditis patients have not improved over time.
Conclusions:
- Children with myocarditis present with higher acuity and have inferior post-HT survival compared to DCM patients.
- Pediatric heart transplant outcomes for myocarditis have remained stagnant over three decades.
- Targeted strategies are essential to improve outcomes for pediatric heart transplant recipients with myocarditis.
Background:
There is limited and conflicting information on waitlist and transplant outcomes for children with myocarditis.
Methods:
Retrospective review included children with myocarditis and dilated cardiomyopathy (DCM) listed for HT from January 01, 1993 to December 31, 2019 in the Pediatric Heart Transplant Society database. Clinical characteristics, waitlist and post-HT outcomes (graft loss, rejection, cardiac allograft vasculopathy, infection and malignancy) for children listed from early (1993-2008) and current era (2009-2019) with myocarditis were evaluated and compared to those with DCM.
Results:
Of 9755 children listed, 322 (3.3%) had myocarditis and 3178 (32.6%) DCM. Compared to DCM, children with myocarditis in the early and the current era were significantly more likely to be listed at higher urgency; be in intensive care unit; on mechanical ventilation; extracorporeal membrane oxygenation and ventricular assist device (p < 0.05 for all). While unadjusted analysis revealed lower transplant rates and higher waitlist mortality for children with myocarditis, in multivariable analysis, myocarditis was not a risk factor for waitlist mortality. Myocarditis, however, was a significant risk factor for early phase post-HT graft loss (HR 2.46; p = 0.003). Waitlist and post-HT survival for children with myocarditis were similar for those listed and transplanted in the early era to those listed and transplanted in the current era (p > 0.05 for both).
Conclusions:
Children with myocarditis have a higher acuity of illness at listing and at HT and have inferior post-HT survival compared to children with DCM. Outcomes for children with myocarditis have not improved over the 3 decades and efforts are needed to improve outcomes for this cohort.
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