Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
J Heart Lung Transplant. 2012 Aug;31(8):805-10. doi: 10.1016/j.healun.2012.03.018. Epub 2012 May 1.
New anti-neoplastic drugs have improved survival of cancer patients but have also been associated with chemotherapy-induced cardiomyopathy (CCMP), ultimately requiring orthotopic heart transplantation (OHT). We conducted this study to describe the clinical characteristics and outcomes of patients with CCMP treated with OHT and compare them with outcomes of patients with other forms of non-ischemic cardiomyopathy (NICMP).
We retrospectively identified 232 CCMP patients and 8,890 NICMP patients from the International Society of Heart and Lung Transplantation Registry who underwent OHT between January 2000 and December 2008. Survival rates were calculated using the Kaplan-Meier method. Categoric characteristics and outcomes groups were compared using the χ(2) and Fisher exact test. Comparisons for continuous variables were made using Wilcoxon-Mann-Whitney test. Multivariable analyses of predictors of survival were performed using Cox proportional hazard regression analysis.
Short-term and long-term post-transplant survival of the 232 CCMP patients was similar to the 8,890 NICMP patients (p = 0.19). Survival (95% confidence interval) at 1, 3, and 5 years was, respectively, 86% (0.81-0.91), 79% (0.76-0.87), and 71% 0.73-0.85) in the CCMP patients and 87% (0.86-0.88), 81% (0.82-0.84), and 74% (0.80-0.81) in the NICMP patients (p = 0.19). Compared with NICMP patients, CCMP patients had higher rates of post-OHT infection (22% vs 14%, p = 004) and malignancies (5% vs 2%, p = 0.006), but neither affected survival. There was only 1 malignancy recurrence in the CCMP patients and no differences in post-OHT death due to malignancies between the groups. Importantly, CCMP patients were twice as likely as NICMP patients to require right ventricular assist devices before OHT (5.6% vs 2.3%, p = 0.0021).
Patients with CCMP selected for OHT are younger, have less comorbidity, and are more likely to require biventricular mechanical support pre-OHT than other NICMP patients who receive allografts. Despite the higher incidence of malignancy and infection in CCMP patients who have received a heart transplant, their survival is comparable to those who receive allografts for other cardiomyopathies.
新的抗肿瘤药物提高了癌症患者的生存率，但也与化疗引起的心肌病（CCMP）相关，最终需要进行原位心脏移植（OHT）。我们进行这项研究，旨在描述接受 OHT 的 CCMP 患者的临床特征和结局，并将其与接受其他非缺血性心肌病（NICMP）患者的结局进行比较。
我们从国际心肺移植协会注册中心回顾性地确定了 2000 年 1 月至 2008 年 12 月期间接受 OHT 的 232 例 CCMP 患者和 8890 例 NICMP 患者。使用 Kaplan-Meier 方法计算生存率。使用 χ(2)和 Fisher 确切检验比较分类特征和结局组。使用 Wilcoxon-Mann-Whitney 检验比较连续变量。使用 Cox 比例风险回归分析对生存的预测因素进行多变量分析。
232 例 CCMP 患者的短期和长期移植后生存率与 8890 例 NICMP 患者相似（p=0.19）。CCMP 患者的 1、3 和 5 年生存率（95%置信区间）分别为 86%（0.81-0.91）、79%（0.76-0.87）和 71%（0.73-0.85），NICMP 患者分别为 87%（0.86-0.88）、81%（0.82-0.84）和 74%（0.80-0.81）（p=0.19）。与 NICMP 患者相比，CCMP 患者在 OHT 后感染（22%对 14%，p=0.04）和恶性肿瘤（5%对 2%，p=0.006）的发生率更高，但均未影响生存率。CCMP 患者仅有 1 例恶性肿瘤复发，两组间 OHT 后因恶性肿瘤而死亡的情况无差异。重要的是，与 NICMP 患者相比，CCMP 患者在接受 OHT 前更有可能需要右心室辅助装置（5.6%对 2.3%，p=0.0021）。
选择接受 OHT 的 CCMP 患者比接受同种异体移植物的其他 NICMP 患者更年轻，合并症更少，并且在接受 OHT 前更有可能需要双心室机械支持。尽管接受心脏移植的 CCMP 患者恶性肿瘤和感染的发生率更高，但他们的生存率与接受其他心肌病同种异体移植物的患者相似。
