Objective The aim of study was to estimate outcomes of recipients with non-ischaemic chronic heart failure (CHF) after heart transplantation (HT).
Methods From 2010 to 2016 we heart transplanted 80 recipients: 52.5% (n=42) – with non-ischaemic CHF (mean age – 38.3±2,2 years, n=4 children (mean age – 13.5±2.6 years)), 47.5% (n=38) – with ischaemic heart disease (IHD). Causes of CHF (mean LVEF – 20.9±1.8%) in non-ischaemic group: dilated cardiomyopathy (61.9%, n=26), non-compacted myocardium (21.4%, n=9), rheumatic heart disease (4.8%, n=2), arrhythmogenic right ventricular dysplasia (7.1%, n=3) and others (n=1 cardiac amyloidosis, n=1 cardiac sarcoidosis). Furthermore, 19% (n=8) of them were supported by biventricular assist device Berlin Heart EXCOR (duration on support – 234±80 days) prior HT. According to right heart catheterization results: pulmonary arterial systolic pressure (PASP) 39.9±1.9 mmHg, pulmonary vascular resistance (PVR) – 2.9±0.2 W.U. Pulmonary hypertension was diagnosed in 66.7% (n=28) recipients. There was no difference in how much time patients spent in HT waiting list (158.9±23.8 days vs. 152.4±29.4 days, p>0.05). All recipients treated by triple-drug therapy (steroids, calcineurin inhibitors, mycophenolic acid), induction: basiliximab – 62% (n=26), thymoglobulin – 38% (n=16). Outcomes of HT were estimated by survival, TTE results, frequency of rejection, frequency of cardiac allograft vasculopathy (CAV) and cardiopulmonary exercise test results.
Results After 6 year follow-up survival was comparable with IHD recipients (30.4±3,1 months vs. 27.3±4.2 months, p>0.05), but mortality during 1st yr after HT was higher in IHD group (7.1% vs. 13.1%, p<0.001). After HT non-ischaemic patients spent less time in ICU (9.3±0.9 days vs. 11.5±1.6 days, p>0.05), the same as required inotrope support (6.1±0.6 days vs. 8.5±1.4 days, p<0.05). Only 9.5% (n=4) of recipients had severe right heart failure and required extracorporeal membrane oxygenation (ECMO) support, 7% (n=3) – underwent tricuspid valve repair due to severe tricuspid regurgitation. Levosimendan treatment was successfully used in 33.3% (n=14) patients. In 1 case thoracoscopic pericardial fenestration performed. In 6 months after HT TTE results got to normal values: LVEF – 60.6±0.9%, PASP – 31.1±1.3 mm Hg; results were stable even in 1 year. During 1st yr rejection was found: R2/3A – 9.5% (n=32), AMR1 – 2.1% (n=7). Also in 1 year after HT recipients from non-ischaemic group significantly improved their physical capacity (V02peak – 11.7±0.4 ml/min/kg vs. 17.8±0.6 ml/min/kg, p<0.001). CAV was diagnosed in more than 1 year of follow-up. Furthermore, frequency of CAV was more often in IHD group (9.5% (n=4) vs. 13.2% (n=5), p<0.05).
Conclusion After HT survival and complications are comparable in recipients with IHD and non-ischaemic group.
- heart transplantation
- non-ischaemic heart failure