Chantal A Elamm1, Sadeer G Al-Kindi1, Christopher M Bianco1, Bishnu P Dhakal1, Guilherme H Oliveira2. 1. Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. 2. Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. Electronic address: guiherme.oliveira@uhhospitals.org.
Abstract
BACKGROUND: Giant cell myocarditis (GCM) is a lethal, rapidly progressive disease, for which heart transplantation is the treatment of choice. We sought to describe the characteristics and outcomes of patients with GCM who undergo heart transplantation. METHODS AND RESULTS: We used the United Network for Organ Sharing thoracic organ transplantation registry to identify adults with GCM as the primary diagnosis and compared their characteristics and outcomes with patients who underwent transplantation for other types of myocarditis and for idiopathic dilated cardiomyopathy (IDCMP). A total of 32 patients with GCM were compared with 219 patients with myocarditis and 14,221 patients with IDCMP. Median age at listing for GCM was 52 years (interquartile range 40-55 y), and the majority were white (94%), male (63%), and listed as 1A (44%). Biventricular assist devices were used more frequently in GCM compared with IDCMP (31% vs 2%; P < .001). After transplantation, there were no statistically significant differences among GCM, myocarditis, and IDCMP patients regarding pacemaker implantation, dialysis initiation, or stroke rate. GCM patients had increased risk of acute rejection compared with IDCMP patients (16% vs 5.0%; P = .021) but no difference in rehospitalization for rejection among the 3 etiologies (P = .88). The cumulative survivals for GCM patients at 1, 5, and 10 years were 94%, 82%, and 68%, respectively, which was similar to the other etiologies (P = .11). CONCLUSIONS: Compared with patients with IDCMP, those with GCM present more acutely and have significantly higher utilization of biventricular mechanical circulatory support. Despite higher rates of early rejection, post-transplantation survival of patients with GCM was similar to that of other myocarditides and IDCMP.
BACKGROUND: Giant cell myocarditis (GCM) is a lethal, rapidly progressive disease, for which heart transplantation is the treatment of choice. We sought to describe the characteristics and outcomes of patients with GCM who undergo heart transplantation. METHODS AND RESULTS: We used the United Network for Organ Sharing thoracic organ transplantation registry to identify adults with GCM as the primary diagnosis and compared their characteristics and outcomes with patients who underwent transplantation for other types of myocarditis and for idiopathic dilated cardiomyopathy (IDCMP). A total of 32 patients with GCM were compared with 219 patients with myocarditis and 14,221 patients with IDCMP. Median age at listing for GCM was 52 years (interquartile range 40-55 y), and the majority were white (94%), male (63%), and listed as 1A (44%). Biventricular assist devices were used more frequently in GCM compared with IDCMP (31% vs 2%; P < .001). After transplantation, there were no statistically significant differences among GCM, myocarditis, and IDCMP patients regarding pacemaker implantation, dialysis initiation, or stroke rate. GCM patients had increased risk of acute rejection compared with IDCMP patients (16% vs 5.0%; P = .021) but no difference in rehospitalization for rejection among the 3 etiologies (P = .88). The cumulative survivals for GCM patients at 1, 5, and 10 years were 94%, 82%, and 68%, respectively, which was similar to the other etiologies (P = .11). CONCLUSIONS: Compared with patients with IDCMP, those with GCM present more acutely and have significantly higher utilization of biventricular mechanical circulatory support. Despite higher rates of early rejection, post-transplantation survival of patients with GCM was similar to that of other myocarditides and IDCMP.
Authors: Emanuele Bobbio; Marie Björkenstam; Bright I Nwaru; Francesco Giallauria; Eva Hessman; Niklas Bergh; Christian L Polte; Jukka Lehtonen; Kristjan Karason; Entela Bollano Journal: Clin Res Cardiol Date: 2021-08-17 Impact factor: 5.460
Authors: Enrico Ammirati; Emanuele Bizzi; Giacomo Veronese; Matthieu Groh; Caroline M Van de Heyning; Jukka Lehtonen; Marc Pineton de Chambrun; Alberto Cereda; Chiara Picchi; Lucia Trotta; Javid J Moslehi; Antonio Brucato Journal: Front Med (Lausanne) Date: 2022-03-07
Authors: Enrico Ammirati; Maria Frigerio; Leslie T Cooper; Paolo G Camici; Eric D Adler; Cristina Basso; David H Birnie; Michela Brambatti; Matthias G Friedrich; Karin Klingel; Jukka Lehtonen; Javid J Moslehi; Patrizia Pedrotti; Ornella E Rimoldi; Heinz-Peter Schultheiss; Carsten Tschöpe Journal: Circ Heart Fail Date: 2020-11-12 Impact factor: 8.790