Assessing the Role of Primary Heart Failure Etiology on Cardiac Transplant Outcomes

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-08-30 DOI:10.1111/ctr.15450

Ahad Firoz, Roh Yanagida, Mohammed Kashem, Yoshiya Toyoda, Eman Hamad

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Abstract

Background

There are diverse indications for heart transplantation (HTx), often categorized into ischemic (ICM) and nonischemic (NICM) cardiomyopathy. Although there is extensive research comparing the outcomes for these disease processes following certain therapeutic interventions, there are limited data on how recipient etiology impacts post-HTx survival. Our investigation seeks to identify this relationship.

Methods

We conducted a retrospective analysis using adult HTx patients from the United Network for Organ Sharing database between 2000 and 2021. Patients with a combined heart–lung transplant or previous HTx were excluded. ICM included coronary artery disease (CAD) and ischemic dilated cardiomyopathy. NICM included nonischemic dilated (NIDCM), hypertrophic (HCM), and restrictive (RCM) cardiomyopathy. Overall survival was analyzed using Kaplan–Meier curves, log-rank tests, and multivariable Cox regression models.

Results

A total of 42 268 patients were included in our study. Recipients with ICM were older and more likely to be males, obese, diabetics, and smokers. We found that patients with ICM had an increased incidence of transplant CAD (OR = 1.23, p < 0.001) and risk of mortality (hazard ratio [HR] = 1.22, p < 0.001) compared to NICM. When NICM was expanded, RCM had a similar hazard risk compared to ICM (HR = 1.03, p = 0.650), whereas both NIDCM (HR = 0.81, p < 0.001) and HCM (HR = 0.70, p < 0.001) had improved survival.

Conclusion

Our study provides evidence to suggest that ICM has decreased survival when compared to NICM. When NICM was expanded, RCM was found to have an increased mortality risk similar to ICM, whereas NIDCM and HCM both had superior outcomes. The clinical implication of this investigation will allow clinicians to better understand the prognosis of certain patient groups.

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评估原发性心力衰竭病因对心脏移植结果的影响

背景心脏移植（HTx）的适应症多种多样，通常分为缺血性（ICM）和非缺血性（NICM）心肌病。尽管有大量研究比较了这些疾病过程在接受某些治疗干预后的结果，但关于受体病因如何影响心脏移植后存活率的数据却很有限。我们的调查旨在确定这种关系。方法我们利用 2000 年至 2021 年期间器官共享联合网络数据库中的成人 HTx 患者进行了一项回顾性分析。排除了合并心肺移植或既往接受过 HTx 的患者。ICM 包括冠状动脉疾病（CAD）和缺血性扩张型心肌病。NICM包括非缺血性扩张型（NIDCM）、肥厚型（HCM）和限制型（RCM）心肌病。采用 Kaplan-Meier 曲线、对数秩检验和多变量 Cox 回归模型对总生存率进行了分析。结果本研究共纳入 42 268 例患者。ICM 受体年龄较大，男性、肥胖、糖尿病患者和吸烟者较多。我们发现，与 NICM 相比，ICM 患者的移植 CAD 发生率（OR = 1.23，p < 0.001）和死亡风险（危险比 [HR] = 1.22，p < 0.001）均有所增加。当 NICM 扩大时，RCM 的危险风险与 ICM 相似（HR = 1.03，p = 0.650），而 NIDCM（HR = 0.81，p <0.001）和 HCM（HR = 0.70，p <0.001）的生存率均有所提高。结论我们的研究提供的证据表明，与 NICM 相比，ICM 的存活率更低。在扩大 NICM 的范围后，发现 RCM 的死亡风险增加与 ICM 相似，而 NIDCM 和 HCM 的预后均优于 ICM。这项研究的临床意义将使临床医生更好地了解某些患者群体的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.