Amdani Shahnawaz, Korang Alfred-Asante, Law Yuk, Cantor Ryan, Koehl Devin, Kirklin James K, Ybarra Marion, Rusconi Paolo, Azeka Estela, Ruiz Adriana Carolina Prada, Schowengerdt Kenneth, Bostdorff Hannah, Joong Anna
Department of Pediatric Cardiology, Cleveland Clinic Children's, Ohio.
Johns Hopkins All Children's Heart Institute, Saint Petersburg, Florida.
J Heart Lung Transplant. 2023 Jan;42(1):89-99. doi: 10.1016/j.healun.2022.07.013. Epub 2022 Jul 21.
There is limited and conflicting information on waitlist and transplant outcomes for children with myocarditis.
Retrospective review included children with myocarditis and dilated cardiomyopathy (DCM) listed for HT from January 01, 1993 to December 31, 2019 in the Pediatric Heart Transplant Society database. Clinical characteristics, waitlist and post-HT outcomes (graft loss, rejection, cardiac allograft vasculopathy, infection and malignancy) for children listed from early (1993-2008) and current era (2009-2019) with myocarditis were evaluated and compared to those with DCM.
Of 9755 children listed, 322 (3.3%) had myocarditis and 3178 (32.6%) DCM. Compared to DCM, children with myocarditis in the early and the current era were significantly more likely to be listed at higher urgency; be in intensive care unit; on mechanical ventilation; extracorporeal membrane oxygenation and ventricular assist device (p < 0.05 for all). While unadjusted analysis revealed lower transplant rates and higher waitlist mortality for children with myocarditis, in multivariable analysis, myocarditis was not a risk factor for waitlist mortality. Myocarditis, however, was a significant risk factor for early phase post-HT graft loss (HR 2.46; p = 0.003). Waitlist and post-HT survival for children with myocarditis were similar for those listed and transplanted in the early era to those listed and transplanted in the current era (p > 0.05 for both).
Children with myocarditis have a higher acuity of illness at listing and at HT and have inferior post-HT survival compared to children with DCM. Outcomes for children with myocarditis have not improved over the 3 decades and efforts are needed to improve outcomes for this cohort.
关于心肌炎患儿的等待名单和移植结果的信息有限且相互矛盾。
回顾性研究纳入了1993年1月1日至2019年12月31日在儿科心脏移植协会数据库中登记等待心脏移植（HT）的心肌炎和扩张型心肌病（DCM）患儿。评估并比较了早期（1993 - 2008年）和当前时期（2009 - 2019年）登记的心肌炎患儿的临床特征、等待名单和心脏移植后结果（移植物丢失、排斥反应、心脏移植血管病变、感染和恶性肿瘤），并与DCM患儿进行对比。
在9755名登记患儿中，322名（3.3%）患有心肌炎，3178名（32.6%）患有DCM。与DCM患儿相比，早期和当前时期的心肌炎患儿更有可能在更高紧急程度下登记；入住重症监护病房；接受机械通气；使用体外膜肺氧合和心室辅助装置（所有p < 0.05）。虽然未调整分析显示心肌炎患儿的移植率较低且等待名单死亡率较高，但在多变量分析中，心肌炎不是等待名单死亡率的危险因素。然而，心肌炎是心脏移植后早期移植物丢失的重要危险因素（风险比2.46；p = 0.003）。早期登记和移植的心肌炎患儿与当前时期登记和移植的患儿在等待名单和心脏移植后的生存率相似（两者p > 0.05）。
与DCM患儿相比，心肌炎患儿在登记和心脏移植时病情更严重，心脏移植后的生存率较低。心肌炎患儿的结局在过去30年中没有改善，需要努力改善该队列患儿的结局。
