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Long-term post-transplantation outcomes in patients with hypertrophic cardiomyopathy: Single-center 35-year

Matylda Mazur1, Geetha Bhat1, Eric Popjes1

  • 1Heart and Vascular Institute, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

Clinical Transplantation
|February 21, 2024
PubMed

Insights

Heart transplantation (HT) outcomes for hypertrophic cardiomyopathy (HCM) patients are favorable long-term. Despite a more challenging initial recovery, HCM individuals experience similar survival and freedom from rejection as other cardiomyopathy groups.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Cardiovascular Surgery

Background:

  • Heart transplantation (HT) is a critical treatment for end-stage heart failure and hypertrophic cardiomyopathy (HCM) unresponsive to medical therapy.
  • Long-term outcomes following HT in patients with HCM are not well-documented.

Purpose of the Study:

  • To evaluate and compare the long-term outcomes of heart transplantation in adult patients with hypertrophic cardiomyopathy (HCM) versus those with ischemic or dilated cardiomyopathy.
  • To assess survival rates, allograft rejection, cardiac allograft vasculopathy (CAV), and need for post-transplant support.

Main Methods:

  • A retrospective analysis of 319 adult patients who underwent HT between 1984 and 2019.
  • Comparison of outcomes among 24 HCM patients, 160 ischemic cardiomyopathy patients, and 135 dilated cardiomyopathy patients.
  • Follow-up included monitoring for rejection, CAV, death, re-transplantation, and immediate post-HT support requirements.

Main Results:

  • The 10-year survival rate was comparable across groups (67% HCM, 62% ischemic, 69% dilated; p=0.04).
  • HCM patients required more prolonged inotropic support (37%), mechanical circulatory support (45%), and renal replacement therapy (55%) immediately post-HT.
  • No significant differences were observed in 10-year freedom from acute rejection (38%) or CAV (88%) among the groups.

Conclusions:

  • Adult patients with HCM have a favorable long-term prognosis after heart transplantation.
  • The immediate post-transplant period for HCM patients is more complex, requiring intensive support.
  • Long-term graft survival and rejection rates are similar to other common cardiomyopathy indications for HT.
Abstract

Keywords:
heart failureheart transplantationhypertrophic cardiomyopathy

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