Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Card Fail. 2017 Jul;23(7):566-569. doi: 10.1016/j.cardfail.2017.04.015. Epub 2017 Apr 24.
Giant cell myocarditis (GCM) is a lethal, rapidly progressive disease, for which heart transplantation is the treatment of choice. We sought to describe the characteristics and outcomes of patients with GCM who undergo heart transplantation.
We used the United Network for Organ Sharing thoracic organ transplantation registry to identify adults with GCM as the primary diagnosis and compared their characteristics and outcomes with patients who underwent transplantation for other types of myocarditis and for idiopathic dilated cardiomyopathy (IDCMP). A total of 32 patients with GCM were compared with 219 patients with myocarditis and 14,221 patients with IDCMP. Median age at listing for GCM was 52 years (interquartile range 40-55 y), and the majority were white (94%), male (63%), and listed as 1A (44%). Biventricular assist devices were used more frequently in GCM compared with IDCMP (31% vs 2%; P < .001). After transplantation, there were no statistically significant differences among GCM, myocarditis, and IDCMP patients regarding pacemaker implantation, dialysis initiation, or stroke rate. GCM patients had increased risk of acute rejection compared with IDCMP patients (16% vs 5.0%; P = .021) but no difference in rehospitalization for rejection among the 3 etiologies (P = .88). The cumulative survivals for GCM patients at 1, 5, and 10 years were 94%, 82%, and 68%, respectively, which was similar to the other etiologies (P = .11).
Compared with patients with IDCMP, those with GCM present more acutely and have significantly higher utilization of biventricular mechanical circulatory support. Despite higher rates of early rejection, post-transplantation survival of patients with GCM was similar to that of other myocarditides and IDCMP.
巨细胞心肌炎（GCM）是一种致命的、快速进展的疾病，心脏移植是其首选治疗方法。我们旨在描述接受心脏移植的 GCM 患者的特征和结局。
我们使用美国器官共享联合网络（UNOS）的胸器官移植登记处，确定了原发性 GCM 诊断的成年患者，并将其特征和结局与接受其他类型心肌炎和特发性扩张型心肌病（IDCMP）心脏移植的患者进行比较。共比较了 32 例 GCM 患者与 219 例心肌炎患者和 14221 例 IDCMP 患者。GCM 患者的中位列入名单年龄为 52 岁（四分位距 40-55 岁），大多数为白人（94%）、男性（63%）和 1A 期（44%）。与 IDCMP 相比，GCM 患者更常使用双心室辅助装置（31%比 2%；P<0.001）。移植后，GCM、心肌炎和 IDCMP 患者之间在起搏器植入、开始透析或卒中率方面没有统计学差异。与 IDCMP 患者相比，GCM 患者发生急性排斥反应的风险更高（16%比 5.0%；P=0.021），但在 3 种病因中，因排斥反应再住院治疗的差异无统计学意义（P=0.88）。GCM 患者的 1、5 和 10 年累积生存率分别为 94%、82%和 68%，与其他病因相似（P=0.11）。
与 IDCMP 患者相比，GCM 患者的起病更急，双心室机械循环支持的使用率明显更高。尽管早期排斥反应的发生率较高，但 GCM 患者移植后的生存率与其他心肌炎和 IDCMP 相似。
