Survival Following Cardiac Transplantation in Patients with Hypertrophic Cardiomyopathy
Background—Heart transplant is a treatment for selected patients with hypertrophic cardiomyopathy (HCM). However, the prevalence, clinical profile and outcome of this subgroup of HCM patients are uncertain. Therefore, we sought to determine the occurrence, clinical characteristics and prognosis of HCM patients who underwent cardiac transplantation in the United States during a 15-year period.
Methods and Results—Demographic, clinical and survival outcome of 26,706 adult (age ≥18 years) heart-only transplant recipients between January 1990 to December 2004 were acquired from the United Network of Organ Sharing (UNOS) Registry. Pre-transplant diagnoses were classified as: HCM (n=303; 1%) and non-HCM (26,403; 99%) [comprised of threepatient subgroups: 1) ischemic cardiomyopathy (n=14,308; 54%); 2) dilated cardiomyopathy (n=11,760; 44%); and 3) restrictive cardiomyopathy (n=335; 1%)]. Study follow-up began at the time of heart transplant and was 76±44 months among survivors. The 1-, 5-, and 10-year overall transplant survival for HCM patients was 85%, 75%, and 61%, with a trend toward greater survival compared to non-HCM transplant patients (82%, 70%, 49%; log rank test, p=0.05). However, propensity matched, covariate-adjusted Cox regression model analysis showed better survival over time (p<0.01) among the HCM patients. When HCM post-transplant survival was compared to each of the non-HCM patient subgroups, HCM patients had more favorable survival than those transplanted for ischemic cardiomyopathy (p=0.02). In contrast, HCM post-transplant survival did not differ from those patients transplanted for restrictive (p=0.08) or dilated cardiomyopathy (p=0.25).
Conclusions—HCM patients comprise a small subset (1%) of the overall population of patients who undergo heart transplantation in the United States. Nonetheless, survival following transplant among HCM patients is comparable to patients transplanted for non-HCM cardiovascular diseases, with possible enhanced survival over time.
- Received November 11, 2009.
- Accepted July 7, 2010.
- Copyright © 2010, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited