Vieira Jefferson L, Sobral Maria G V, Macedo Francisco Y, Florêncio Raquel S, Almeida Germana P L, Vasconcelos Glauber G, Fernandes Juliana R, Marinho Laura L E, Trompieri Daniel F M, Pasala Tilak K R, Mejia Juan A C, Souza-Neto João D
Heart Failure Division, Hospital de Messejana Dr Carlos Alberto Studart, Fortaleza, Ceará, Brazil.
Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack, NJ.
Transplant Direct. 2022 Jun 24;8(7):e1349. doi: 10.1097/TXD.0000000000001349. eCollection 2022 Jul.
Data on post-heart transplant (HT) survival of patients with Chagas cardiomyopathy (CC) are scarce. We sought to evaluate post-HT survival in patients with CC as compared with other causes of heart failure across different eras of HT.
We conducted a retrospective, cohort study of 376 adult HT recipients between October 1997 and November 2019. Participants were classified according to the etiology of heart failure as CC (N = 66), nonischemic cardiomyopathy (N = 214), and ischemic cardiomyopathy (N = 96), and according to the era of HT as early (1997-2009), recent (2010-2014), and current era (2015-2019).
After a mean follow-up of 5.0 y (0-20.5 y), post-HT survival rates at 1, 5, and 10 y were comparable between groups. One-y survival improved from 70% in the early eras to 80% in the current era (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.41-0.97; = 0.034). After adjustment for sex, age, and mechanical circulatory support, time-related improvement in survival was observed only in patients without CC (HR, 0.54; 95% CI, 0.32-0.91; = 0.019) but not in those with CC (HR, 0.99; 95% CI, 0.36-2.73; = 0.98). Causes of death were similar between patients with CC and the other etiological subgroups.
Posttransplant survival is comparable between patients with CC, nonischemic cardiomyopathy, and ischemic cardiomyopathy. Although survival has improved significantly over years for most HT recipients, it has remained unchanged for those with Chagas disease. These trends underscore the importance of scientific research, policy discussions and a collaborative registry of heart transplantation in Chagas cardiomyopathy.
关于恰加斯心肌病（CC）患者心脏移植（HT）后生存的数据很少。我们试图评估CC患者与不同HT时代其他心力衰竭病因患者的HT后生存率。
我们对1997年10月至2019年11月期间的376名成年HT受者进行了一项回顾性队列研究。参与者根据心力衰竭病因分为CC组（N = 66）、非缺血性心肌病组（N = 214）和缺血性心肌病组（N = 96），并根据HT时代分为早期（1997 - 2009年）、近期（2010 - 2014年）和当前时代（2015 - 2019年）。
平均随访5.0年（0 - 20.5年）后，各组之间1年、5年和10年的HT后生存率相当。1年生存率从早期的70%提高到当前时代的80%（风险比[HR]，0.63；95%置信区间[CI]，0.41 - 0.97；P = 0.034）。在对性别、年龄和机械循环支持进行调整后，仅在无CC的患者中观察到生存时间相关的改善（HR，0.54；95% CI，0.32 - 0.91；P = 0.019），而CC患者未观察到（HR，0.99；95% CI，0.36 - 2.73；P = 0.98）。CC患者与其他病因亚组患者的死亡原因相似。
CC患者、非缺血性心肌病患者和缺血性心肌病患者的移植后生存率相当。尽管多年来大多数HT受者的生存率有显著提高，但恰加斯病患者的生存率保持不变。这些趋势强调了恰加斯心肌病科学研究、政策讨论和心脏移植协作登记的重要性。
