Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Card Fail. 2018 Jun;24(6):384-391. doi: 10.1016/j.cardfail.2018.02.009. Epub 2018 Mar 1.
Patients with end-stage cardiomyopathy due to cardiac sarcoidosis (CS) may be referred for mechanical circulatory support (MCS) and heart transplantation (HT). We describe outcomes of patients with CS undergoing HT, focusing on the use of MCS as a bridge to transplant (BTT).
Using the United Network for Organ Sharing Scientific Registry of Transplant Recipients, we identified all adult waitlisted patients and isolated HT recipients from 2006 to 2015. These were divided into those with and without CS and further divided into those who did or did not receive MCS as BTT. Outcomes included 1- and 5-year post-transplantation freedom from mortality and 5-year freedom from primary graft failure.
Over the study period, 31,528 patients were listed for HT, 148 (0.4%) of whom had CS. Among the CS patients, 34 (23%) received MCS as BTT. 18,348 patients (58%) eventually underwent HT, including 67 (0.4%) with CS, 20 (30%) of whom had received BTT MCS. Compared with non-CS diagnoses, CS patients had similar 1-year (91% vs 90%; log rank P = .88) and 5-year (83% vs 77%; log rank P = .46) freedom from mortality. Survival was also similar between CS BTT and non-CS BTT groups at 1 year (89% vs 89%; log-rank P = .92) and 5 years (72% vs 75%; log-rank P = .77).
Survivals after HT were similar between CS and non-CS patients out to 5 years, and were also similar between CS and non-CS BTT cohorts. Both HT and BTT MCS should be considered in patients with CS.
患有心脏结节病（CS）导致终末期心肌病的患者可能会被转介接受机械循环支持（MCS）和心脏移植（HT）。我们描述了 CS 患者接受 HT 的结果，重点介绍了将 MCS 用作移植桥接（BTT）的情况。
使用美国器官共享联合网络器官移植受者科学注册处，我们从 2006 年至 2015 年确定了所有成年待移植患者和 HT 受者，并将其分为 CS 患者和非 CS 患者，并进一步分为接受或未接受 MCS 作为 BTT 的患者。结果包括移植后 1 年和 5 年的死亡率和 5 年原发性移植物衰竭的无失败率。
在研究期间，有 31528 名患者被列入 HT 名单，其中 148 名（0.4%）患有 CS。在 CS 患者中，有 34 名（23%）接受了 MCS 作为 BTT。18348 名患者（58%）最终接受了 HT，其中 67 名（0.4%）患有 CS，其中 20 名（30%）接受了 BTT MCS。与非 CS 诊断相比，CS 患者在 1 年时（91%比 90%；对数秩 P=0.88）和 5 年时（83%比 77%；对数秩 P=0.46）的死亡率无差异。CS BTT 和非 CS BTT 组在 1 年时（89%比 89%；对数秩 P=0.92）和 5 年时（72%比 75%；对数秩 P=0.77）的生存率也相似。
CS 和非 CS 患者在 5 年内的 HT 后生存率相似，CS 和非 CS BTT 队列之间的生存率也相似。在 CS 患者中，应考虑进行 HT 和 BTT MCS。
