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Heart Transplantation in Muscular Dystrophy Patients: Is It a Viable Option?
Abstracts S189 transplants were BTT with MCS (11 LVADs, 1 BiVAD): 6 received VADs prior to listing and 6 while listed. The most commonly implanted devices were HeartMate II (n= 6, 50%) and HeartWare HVAD (n= 2, 17%). CS and non-CS pts had a similar 1-yr freedom from mortality after HT (89 vs 90%, log rank p= 0.86). When compared to CS pts that were not bridged, BTT CS pts had worse 1-yr (75 vs 96%, log rank p= 0.06) and 5-yr freedom from mortality (66 vs 92%, log rank p= 0.04) (Figure 1). There were, however, no significant differences in survival between BTT CS pts and BTT pts with other indications for transplant (1-yr: 75 vs 89%, log rank p= 0.12; 5-yr: 66 vs 75%, log rank p= 0.29). Over the study period, CS pts experienced an 86% 5-yr freedom from graft loss. There was a trend towards reduced freedom from graft loss in the BTT CS population vs the non-bridge (69% vs 92%, p= 0.07). Conclusion: Survival after HT in CS pts is favorable. While BTT CS pts experienced worse survival than non-bridged pts, their survival was still comparable to pts undergoing HT for other indications. Both HT and MCS as a BTT strategy should be considered in this population.
HR= 0.63(0.44-0.90), p= 0.012] mortality post-transplant, in comparison to non CS recipients (Figure 1). Conclusion: In this largest registry based analysis to date, HT for CS had similar 1-year and better intermediate and long term survival than HT due to non-sarcoid indications.
4( 86) Heart Transplantation in Muscular Dystrophy Patients: Is It a Viable Option? R. Rizwan ,1 J.L. Jefferies,2 R. Bryant III,1 G.A. Pettengill,1 T.D. Ryan,2 A. Lorts,2 C. Chin,2 F. Zafar,1 D.L. Morales.1 1Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 2Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
4( 85) Survival After Heart Transplantation in Patients with Cardiac Sarcoidosis - A UNOS Registry Analysis S. Madan ,1 S.R. Patel,1 D. Sims,1 J. Shin,1 D. Goldstein,2 U.P. Jorde,1 O. Saeed.1 1Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; 2Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY. Purpose: Patients with cardiac sarcoidosis (CS) may be turned down for heart transplantation (HT) due to concerns for recurrence of sarcoidosis in the transplanted heart or involvement of other organs. Previous studies have reported conflicting survival outcomes after HT in patients with CS and long term mortality remains unknown. Methods: We identified 150 adults (≥ 18 years) who underwent HT for CS in the UNOS registry between 1987 and 2015. These were compared to patients who underwent HT due to other conditions (n= 50,949) in the same period for post HT mortality up to 10 years of follow up. Survival was compared between groups by using Kaplan Meier analysis and adjusted Cox proportional hazards ratios (Cox HR) were generated. Results: HT recipients with CS were younger [51 (46-58) vs 54 (46-61) years, p= 0.02], more likely to be black (25.3% vs 14.5 %, p< 0.01), and had higher CMV mismatch (19.3% vs 12.4%, p= 0.01), when compared to non CS patients. Both groups were similar for sex-mismatch, size-mismatch, UNOS status 1 a, total wait list time, VAD or CF-LVAD support, donor age, ischemic time and donor cause of death. HT recipients with CS had similar 1-year mortality [Cox HR= 0.79(0.47-1.34), p= 0.390], but significantly lower 5-year [Cox HR= 0.57(0.36-0.90), p= 0.015] and 10-year [Cox
Purpose: Cardiomyopathy (CM) is a common complication among patients with muscular dystrophy (MD) & may result in advanced heart failure (HF) & premature death. Despite a high incidence of HF in this cohort, there is hesitancy to consider heart transplantation (HTx). We aim to analyze the post transplant (Tx) outcomes of the MD patients undergoing HTx. Methods: The UNOS database was queried (October 1987-March 2016), identifying all HTx recipients. Patients were divided into 2 groups based on their diagnosis for Tx: MD cohort (81) & all other cardiomyopathies cohort (41,317). Propensity score matching (ratio 1:2) was done on age, Tx year, recipient renal function & inotropic support at Tx (matched cohort: 162). Patient characteristics & post-Tx outcomes were compared between the MD & matched CM cohort. Results: Becker’s was the most common type of MD in this cohort [Figure]. No difference was observed in the median age (MD vs Other: 22y vs 22y; p= 0.74) & the proportion of adolescents (MD vs Other: 23 (28%) vs 34 (21%); p= 0.20) between the cohorts. MD cohort had similar total bilirubin (median: 0.9 mg/dl [0.6-1.4]), incidence of inotropic support (44, 54%), ventilator support (0, 0%), ventricular assist device support (13, 16%) & chronic steroid use (7, 8.6%) compared to the control group (p> 0.05). Median time on wait-list was also similar between the 2 groups (MD vs Other: 52d vs 48d; p= 0.61). Post Tx survival of MD cohort was the same when compared to matched other CM HTx (p= 0.10) patients & was better than the unmatched cohort (p< 0.01). [Figure] Among the types of MD, no difference was observed in post Tx survival of Becker’s MD versus NonBecker’s MD (p= 0.12). Conclusion: MD patients undergoing HTx have similar long term post-Tx outcomes compared to matched CM-related HTx recipients. The majority of recipients were of the Becker's MD genotype. HTx appears to be an effective treatment for a select group of MD patients by prolonging their survival, however, its effect on quality of life should be a key determining factor & will need further evaluation.
S190
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017 Results: A total of 48,952 patients were included. The median (inter-quartile range) age at primary transplant was 54 (43-60) years, and 24% of patients were female. During a median follow-up of 4 (1-8) years, 15,935 (32.6%) recipients died. Survival at ten years was 55.5% for underweight, 58.9% for normal BMI, 56.8% for overweight, 52.1% for obesity class I, 53.9% for obesity class II, and 47.1% for obesity class III patients (p< 0.001). By multivariable analysis, obesity was associated with significantly higher posttransplant mortality risk in comparison to other patients (Class I HR 1.12, 95% CI 1.07-1.17; Class II HR 1.06, 95% CI 0.98-1.16; Class III HR 1.38, 95% CI 1.12-1.69). Assessing cause-specific mortality, death due to cardiac allograft vasculopathy (p= 0.03) and acute (p= 0.04) and chronic (p< 0.001) rejection were increased in obese patients, while death due to stroke and myocardial infarction were not. Conclusion: Our study suggests that obese (BMI> 30kg/m2) heart transplant recipients are at increased risk of post-transplant mortality. The risk associated with high BMI should be taken into account at the time of transplant assessment. 4( 88) Young African American Heart Transplant Recipients Have an Elevated Risk of Post-Transplant Mortality H. Maredia ,1 M. Bowring,1 A. Massie,1 S. Oyetunji,1 C. Merlo,2 R. Higgins,1 D. Segev,1 E. Bush.1 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
4( 87) The Effect of Pre-Heart Transplant Obesity on Post-Transplant Mortality: An Analysis of the ISHLT Registry Data B.S. Doumouras ,1 C.S. Fan,2 A.I. Dipchand,3 C. Manlhiot,2 J. Stehlik,4 H.J. Ross,1 A.C. Alba.1 1Heart Failure and Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; 2CV Data Management Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 3Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 4University of Utah School of Medicine, Salt Lake City, UT. Purpose: Due to the paucity of available organs, optimal recipient selection for heart transplantation is necessary to derive maximal benefit. Currently, there is no firm consensus on whether obesity is a contraindication to heart transplantation. Our aim was to evaluate the effect of increased body mass index (BMI) on post-transplant mortality in heart transplant recipients. Methods: We utilized data from the International Society for Heart and Lung Transplantation Transplant Registry between 2000 and 2014. Adult and adolescent patients (age > 14 years) who underwent heart transplant were included. Recipients who underwent re-transplant or simultaneous organ transplant were excluded. The patients were stratified based on pretransplant BMI (kg/m2): < 18.5 (underweight), 18.5-24.99 (normal), 25-29.99 (overweight), 30-34.99 (obesity class I), 35-39.99 (obesity class II), and > 40 (obesity class III). We used Kaplan-Meier analysis and multivariable Cox proportional hazard regression model to evaluate the association of BMI with all-cause and cause-specific post-transplant mortality.
Purpose: African American (AA) race is associated with poorer survival among heart transplant recipients. We examined racial disparities in survival post-heart transplant and explored the potential effect modification of age and race on survival. Methods: Using SRTR, we performed a retrospective observational study of 29,039 adult heart transplant recipients from 1/1/2000-3/3/2016, comparing post-transplant survival in African-American (AA) vs non-AA recipients stratified by age (18-30, 31-40, 41-60 and 61-80). Cox regression was used to compare mortality by race with age as an effect modifier after adjusting for recipient and donor characteristics. Results: AA recipients were older at transplant than non-AA recipients, with median age of (IQR) 51 (40-58) vs 56 (48-62) years (ranksum p< 0.001). In an adjusted model, AA recipients had a 17% higher risk of death than comparable non-AA candidates (aHR = 1.061.171.31, p= 0.003). Survival differed significantly across age categories among both AA and non-AA recipients (Figure; both logrank p< 0.001). The association between AA race and mortality was amplified among younger recipients (p< 0.001 for race/age interaction). Among recipients aged 18-30, AA were at a 1.602.032.59 times higher risk of death relative to non-AA recipients; however, among recipients aged 61-80, AA recipients were at a 1.041.221.44 times higher risk of death compared to non-AA (Table). Conclusion: Young AA recipients aged 18-30 years had the highest risk of death post-transplant relative to other age and race groups. Identifying age as an effect modifier of racial disparities will provide better prognostication for transplant candidates and inform improved surveillance of young AA recipients.
HR= 0.63(0.44-0.90), p= 0.012] mortality post-transplant, in comparison to non CS recipients (Figure 1). Conclusion: In this largest registry based analysis to date, HT for CS had similar 1-year and better intermediate and long term survival than HT due to non-sarcoid indications.
4( 86) Heart Transplantation in Muscular Dystrophy Patients: Is It a Viable Option? R. Rizwan ,1 J.L. Jefferies,2 R. Bryant III,1 G.A. Pettengill,1 T.D. Ryan,2 A. Lorts,2 C. Chin,2 F. Zafar,1 D.L. Morales.1 1Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 2Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
4( 85) Survival After Heart Transplantation in Patients with Cardiac Sarcoidosis - A UNOS Registry Analysis S. Madan ,1 S.R. Patel,1 D. Sims,1 J. Shin,1 D. Goldstein,2 U.P. Jorde,1 O. Saeed.1 1Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; 2Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY. Purpose: Patients with cardiac sarcoidosis (CS) may be turned down for heart transplantation (HT) due to concerns for recurrence of sarcoidosis in the transplanted heart or involvement of other organs. Previous studies have reported conflicting survival outcomes after HT in patients with CS and long term mortality remains unknown. Methods: We identified 150 adults (≥ 18 years) who underwent HT for CS in the UNOS registry between 1987 and 2015. These were compared to patients who underwent HT due to other conditions (n= 50,949) in the same period for post HT mortality up to 10 years of follow up. Survival was compared between groups by using Kaplan Meier analysis and adjusted Cox proportional hazards ratios (Cox HR) were generated. Results: HT recipients with CS were younger [51 (46-58) vs 54 (46-61) years, p= 0.02], more likely to be black (25.3% vs 14.5 %, p< 0.01), and had higher CMV mismatch (19.3% vs 12.4%, p= 0.01), when compared to non CS patients. Both groups were similar for sex-mismatch, size-mismatch, UNOS status 1 a, total wait list time, VAD or CF-LVAD support, donor age, ischemic time and donor cause of death. HT recipients with CS had similar 1-year mortality [Cox HR= 0.79(0.47-1.34), p= 0.390], but significantly lower 5-year [Cox HR= 0.57(0.36-0.90), p= 0.015] and 10-year [Cox
Purpose: Cardiomyopathy (CM) is a common complication among patients with muscular dystrophy (MD) & may result in advanced heart failure (HF) & premature death. Despite a high incidence of HF in this cohort, there is hesitancy to consider heart transplantation (HTx). We aim to analyze the post transplant (Tx) outcomes of the MD patients undergoing HTx. Methods: The UNOS database was queried (October 1987-March 2016), identifying all HTx recipients. Patients were divided into 2 groups based on their diagnosis for Tx: MD cohort (81) & all other cardiomyopathies cohort (41,317). Propensity score matching (ratio 1:2) was done on age, Tx year, recipient renal function & inotropic support at Tx (matched cohort: 162). Patient characteristics & post-Tx outcomes were compared between the MD & matched CM cohort. Results: Becker’s was the most common type of MD in this cohort [Figure]. No difference was observed in the median age (MD vs Other: 22y vs 22y; p= 0.74) & the proportion of adolescents (MD vs Other: 23 (28%) vs 34 (21%); p= 0.20) between the cohorts. MD cohort had similar total bilirubin (median: 0.9 mg/dl [0.6-1.4]), incidence of inotropic support (44, 54%), ventilator support (0, 0%), ventricular assist device support (13, 16%) & chronic steroid use (7, 8.6%) compared to the control group (p> 0.05). Median time on wait-list was also similar between the 2 groups (MD vs Other: 52d vs 48d; p= 0.61). Post Tx survival of MD cohort was the same when compared to matched other CM HTx (p= 0.10) patients & was better than the unmatched cohort (p< 0.01). [Figure] Among the types of MD, no difference was observed in post Tx survival of Becker’s MD versus NonBecker’s MD (p= 0.12). Conclusion: MD patients undergoing HTx have similar long term post-Tx outcomes compared to matched CM-related HTx recipients. The majority of recipients were of the Becker's MD genotype. HTx appears to be an effective treatment for a select group of MD patients by prolonging their survival, however, its effect on quality of life should be a key determining factor & will need further evaluation.
S190
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017 Results: A total of 48,952 patients were included. The median (inter-quartile range) age at primary transplant was 54 (43-60) years, and 24% of patients were female. During a median follow-up of 4 (1-8) years, 15,935 (32.6%) recipients died. Survival at ten years was 55.5% for underweight, 58.9% for normal BMI, 56.8% for overweight, 52.1% for obesity class I, 53.9% for obesity class II, and 47.1% for obesity class III patients (p< 0.001). By multivariable analysis, obesity was associated with significantly higher posttransplant mortality risk in comparison to other patients (Class I HR 1.12, 95% CI 1.07-1.17; Class II HR 1.06, 95% CI 0.98-1.16; Class III HR 1.38, 95% CI 1.12-1.69). Assessing cause-specific mortality, death due to cardiac allograft vasculopathy (p= 0.03) and acute (p= 0.04) and chronic (p< 0.001) rejection were increased in obese patients, while death due to stroke and myocardial infarction were not. Conclusion: Our study suggests that obese (BMI> 30kg/m2) heart transplant recipients are at increased risk of post-transplant mortality. The risk associated with high BMI should be taken into account at the time of transplant assessment. 4( 88) Young African American Heart Transplant Recipients Have an Elevated Risk of Post-Transplant Mortality H. Maredia ,1 M. Bowring,1 A. Massie,1 S. Oyetunji,1 C. Merlo,2 R. Higgins,1 D. Segev,1 E. Bush.1 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
4( 87) The Effect of Pre-Heart Transplant Obesity on Post-Transplant Mortality: An Analysis of the ISHLT Registry Data B.S. Doumouras ,1 C.S. Fan,2 A.I. Dipchand,3 C. Manlhiot,2 J. Stehlik,4 H.J. Ross,1 A.C. Alba.1 1Heart Failure and Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; 2CV Data Management Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 3Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 4University of Utah School of Medicine, Salt Lake City, UT. Purpose: Due to the paucity of available organs, optimal recipient selection for heart transplantation is necessary to derive maximal benefit. Currently, there is no firm consensus on whether obesity is a contraindication to heart transplantation. Our aim was to evaluate the effect of increased body mass index (BMI) on post-transplant mortality in heart transplant recipients. Methods: We utilized data from the International Society for Heart and Lung Transplantation Transplant Registry between 2000 and 2014. Adult and adolescent patients (age > 14 years) who underwent heart transplant were included. Recipients who underwent re-transplant or simultaneous organ transplant were excluded. The patients were stratified based on pretransplant BMI (kg/m2): < 18.5 (underweight), 18.5-24.99 (normal), 25-29.99 (overweight), 30-34.99 (obesity class I), 35-39.99 (obesity class II), and > 40 (obesity class III). We used Kaplan-Meier analysis and multivariable Cox proportional hazard regression model to evaluate the association of BMI with all-cause and cause-specific post-transplant mortality.
Purpose: African American (AA) race is associated with poorer survival among heart transplant recipients. We examined racial disparities in survival post-heart transplant and explored the potential effect modification of age and race on survival. Methods: Using SRTR, we performed a retrospective observational study of 29,039 adult heart transplant recipients from 1/1/2000-3/3/2016, comparing post-transplant survival in African-American (AA) vs non-AA recipients stratified by age (18-30, 31-40, 41-60 and 61-80). Cox regression was used to compare mortality by race with age as an effect modifier after adjusting for recipient and donor characteristics. Results: AA recipients were older at transplant than non-AA recipients, with median age of (IQR) 51 (40-58) vs 56 (48-62) years (ranksum p< 0.001). In an adjusted model, AA recipients had a 17% higher risk of death than comparable non-AA candidates (aHR = 1.061.171.31, p= 0.003). Survival differed significantly across age categories among both AA and non-AA recipients (Figure; both logrank p< 0.001). The association between AA race and mortality was amplified among younger recipients (p< 0.001 for race/age interaction). Among recipients aged 18-30, AA were at a 1.602.032.59 times higher risk of death relative to non-AA recipients; however, among recipients aged 61-80, AA recipients were at a 1.041.221.44 times higher risk of death compared to non-AA (Table). Conclusion: Young AA recipients aged 18-30 years had the highest risk of death post-transplant relative to other age and race groups. Identifying age as an effect modifier of racial disparities will provide better prognostication for transplant candidates and inform improved surveillance of young AA recipients.