Heart transplant outcomes in restrictive cardiomyopathy: UNOS registry analysis of the last three decades

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Daniel J Miklin1, Eugene C DePasquale2

  • 1North Shore University Hospital, Northwell Health, Manhasset, New York.

JHLT Open
|March 27, 2025
PubMed

Insights

Restrictive cardiomyopathy (RCM) heart transplant outcomes are improving, with shorter wait times and better survival rates observed in recent years. Early diagnosis and intervention are crucial for mitigating adverse outcomes in RCM patients awaiting transplantation.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Research

Background:

  • Restrictive cardiomyopathy (RCM) presents diverse etiologies and a generally poor prognosis.
  • While emerging therapies exist, their impact on end-stage RCM and transplant outcomes is still under investigation.
  • Assessing RCM patient outcomes before and after heart transplantation across different time periods is crucial.

Purpose of the Study:

  • To evaluate the temporal trends in heart transplant outcomes for patients with restrictive cardiomyopathy.
  • To compare outcomes in RCM patients across distinct eras: classic (1987-2000), contemporary (2000-2013), and current (2014-2022).
  • To identify prognostic factors and survival differences in RCM patients undergoing heart transplantation.

Main Methods:

  • Retrospective analysis of the United Network of Organ Sharing registry (n=62,709), including 1157 RCM patients.
  • Stratification of RCM patients into three temporal groups: classic, contemporary, and current eras.
  • Comparison of demographics, clinical data, and survival using statistical analyses including Kaplan-Meier and Cox modeling.

Main Results:

  • RCM patients undergoing heart transplant were older, with older donors and longer ischemic times compared to non-RCM recipients.
  • Overall survival for RCM patients post-transplant did not significantly differ from non-RCM patients, despite increased transplant rates.
  • Amyloidosis and chemotherapy/radiation-induced RCM showed poorer prognosis but demonstrated improved survival trends in the current era with shorter waitlist times.

Conclusions:

  • Restrictive cardiomyopathy is a significant indication for heart transplantation, with outcomes showing improvement over time.
  • Shorter wait times and enhanced survival rates are observed across RCM subsets in recent transplant eras.
  • Early identification of RCM is vital for timely intervention and improved management of patients requiring heart transplantation.
Abstract

Keywords:
UNOSheart failureheart transplantationrestrictive cardiomyopathytransplant outcomes

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