Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA.
J Cardiol. 2012 Nov;60(5):407-10. doi: 10.1016/j.jjcc.2012.07.013. Epub 2012 Aug 11.
Controversy exists whether heart transplantation (HTx) is an appropriate treatment option for patients with cardiac sarcoidosis due to its potential recurrence and multi-organ involvement. Recent data from the United Network for Organ Sharing dataset suggest that the clinical outcome of cardiac sarcoidosis patients is equivalent or even better than that of the general HTx population.
We retrospectively reviewed the clinical course of 14 patients with cardiac sarcoidosis among a total of 825 patients who underwent HTx at Columbia University Medical Center between 1997 and 2010. Post-transplant survival of patients with sarcoidosis was compared with that of non-sarcoidosis patients.
More than half of cardiac sarcoidosis patients were initially diagnosed after HTx by tissue analysis of the explanted heart. While only 2/14 cases showed recurrence of cardiac sarcoidosis, the clinical outcome of sarcoid patients showed a trend toward higher mortality than that of non-sarcoidosis patients following HTx (1- and 5-year survival, 78.5 versus 87.2%, 52.4 versus 76.2%, respectively, p=0.09).
Although this is a single-center, retrospective analysis of a small number of cardiac sarcoidosis patients who underwent HTx, a concerning trend toward a higher mortality of patients with cardiac sarcoidosis was noted. A careful candidate selection in patients with known cardiac sarcoidosis should be discussed.
由于心脏结节病有潜在的复发和多器官受累，心脏移植（HTx）是否是心脏结节病患者的合适治疗选择存在争议。来自美国器官共享网络数据集的最新数据表明，心脏结节病患者的临床结果与一般 HTx 人群相当，甚至更好。
我们回顾性分析了 1997 年至 2010 年间在哥伦比亚大学医学中心接受 HTx 的 825 例患者中的 14 例心脏结节病患者的临床病程。将结节病患者的移植后生存率与非结节病患者进行比较。
超过一半的心脏结节病患者在 HTx 后通过对移植心脏的组织分析被最初诊断。虽然只有 2/14 例心脏结节病复发，但 HTx 后结节病患者的临床结果显示出死亡率高于非结节病患者的趋势（1 年和 5 年生存率分别为 78.5%比 87.2%，52.4%比 76.2%，p=0.09）。
尽管这是一项对接受 HTx 的少数心脏结节病患者的单中心、回顾性分析，但注意到心脏结节病患者的死亡率有较高的趋势。应该讨论在已知患有心脏结节病的患者中进行仔细的候选者选择。
