From the Universidad de Panama (J.Z.C.); Hypertrophic Cardiomyopathy Program, University of Utah Health Science Center, Salt Lake City (J.S., C.H.S., S.G.D., S.H.M., O.W.-P.); George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (J.S., C.H.S., S.G.D., S.H.M., O.W.-P.); and Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (J.S., C.H.S., S.G.D., S.H.M., O.W.-P.).
Circ Heart Fail. 2018 Mar;11(3):e004378. doi: 10.1161/CIRCHEARTFAILURE.117.004378.
Current organ allocation policy and the rapid growth of mechanical support favor heart transplant (HT) candidates on left ventricular assist devices. HT candidates with hypertrophic cardiomyopathy (HCM) are usually not left ventricular assist device candidates and may have a disadvantage compared with dilated forms of cardiomyopathy.
Adult HT candidates registered in the Scientific Registry of Transplant Recipients database between 1999 and 2016 were included. HCM candidates were compared with ischemic cardiomyopathy (ICM) and non-ICM patients. Two eras were defined on the basis of the approval date of the first continuous-flow left ventricular assist device for bridge-to-transplant in the United States (2008). Patients outcomes were evaluated while on the waitlist and after HT. The proportion of patients with HCM listed for HT increased by 44% in era 2 compared with era 1. Waitlist mortality in patients with ICM (15.5%-8.7%) and non-ICM (14.2%-8.2%) declined across eras, but minimal decline was observed in HCM patients (11.7%-9.6%; =0.06). In era 2, the 12-month rate of HT in HCM (64.8%) was comparable to that of ICM (60.9%) and non-ICM (62.7%) patients (=0.06). Post-transplant survival in HCM patients was the most favorable in the most recent era (1 year: 91.6% and 5 years: 82.5%; <0.05 for all comparisons).
The number of patients with HCM in need of HT is increasing. Although post-transplant survival in HCM is excellent, waitlist mortality is substantial and with minimal decline in the most recent era, despite the frequent use of listing status upgrade by exception in this patient cohort. Different strategies to improve the performance of the organ allocation system in patients with HCM are needed.
当前的器官分配政策和机械支持的快速发展有利于左心室辅助装置（LVAD）上的心脏移植（HT）候选者。肥厚型心肌病（HCM）的 HT 候选者通常不是 LVAD 候选者，与扩张型心肌病相比可能处于劣势。
本研究纳入了 1999 年至 2016 年期间在移植受者科学登记处数据库中注册的成年 HT 候选者。将 HCM 候选者与缺血性心肌病（ICM）和非-ICM 患者进行比较。根据美国首例用于桥接移植的连续流左心室辅助装置的批准日期，将研究分为两个时期。评估了等待名单和 HT 后患者的结局。与第 1 期相比，第 2 期接受 HT 治疗的 HCM 患者比例增加了 44%。ICM（15.5%-8.7%）和非-ICM（14.2%-8.2%）患者的等待名单死亡率在两个时期均有所下降，但 HCM 患者的下降幅度最小（11.7%-9.6%；=0.06）。在第 2 期，HCM（64.8%）患者的 12 个月 HT 率与 ICM（60.9%）和非-ICM（62.7%）患者相当（=0.06）。在最近的时期，HCM 患者的移植后生存率是最有利的（1 年：91.6%和 5 年：82.5%；所有比较均<0.05）。
需要 HT 的 HCM 患者数量正在增加。尽管 HCM 患者移植后的生存率很高，但等待名单上的死亡率仍然很高，在最近的时期内没有明显下降，尽管在这一患者群体中经常通过例外情况升级列表状态。需要制定不同的策略来改善 HCM 患者器官分配系统的性能。
