Waitlist and post-transplant outcomes for children with myocarditis listed for heart transplantation over 3 decades

Shahnawaz Amdani*, Alfred Asante Korang, Yuk Law, Ryan Cantor, Devin Koehl, James K. Kirklin, Marion Ybarra, Paolo Rusconi, Estela Azeka, Adriana Carolina Prada Ruiz, Kenneth Schowengerdt, Hannah Bostdorff, Anna Joong

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: There is limited and conflicting information on waitlist and transplant outcomes for children with myocarditis. METHODS: Retrospective review included children with myocarditis and dilated cardiomyopathy (DCM) listed for HT from January 01, 1993 to December 31, 2019 in the Pediatric Heart Transplant Society database. Clinical characteristics, waitlist and post-HT outcomes (graft loss, rejection, cardiac allograft vasculopathy, infection and malignancy) for children listed from early (1993-2008) and current era (2009-2019) with myocarditis were evaluated and compared to those with DCM. RESULTS: Of 9755 children listed, 322 (3.3%) had myocarditis and 3178 (32.6%) DCM. Compared to DCM, children with myocarditis in the early and the current era were significantly more likely to be listed at higher urgency; be in intensive care unit; on mechanical ventilation; extracorporeal membrane oxygenation and ventricular assist device (p < 0.05 for all). While unadjusted analysis revealed lower transplant rates and higher waitlist mortality for children with myocarditis, in multivariable analysis, myocarditis was not a risk factor for waitlist mortality. Myocarditis, however, was a significant risk factor for early phase post-HT graft loss (HR 2.46; p = 0.003). Waitlist and post-HT survival for children with myocarditis were similar for those listed and transplanted in the early era to those listed and transplanted in the current era (p > 0.05 for both). CONCLUSIONS: Children with myocarditis have a higher acuity of illness at listing and at HT and have inferior post-HT survival compared to children with DCM. Outcomes for children with myocarditis have not improved over the 3 decades and efforts are needed to improve outcomes for this cohort.

Original languageEnglish (US)
Pages (from-to)89-99
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume42
Issue number1
DOIs
StatePublished - Jan 2023
Externally publishedYes

Keywords

  • children
  • dilated cardiomyopathy
  • mechanical circulatory support
  • myocarditis
  • post-heart transplant outcomes
  • waitlist outcomes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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