Survival After Heart Transplantation in Patients with Adriamycin Associated Cardiomyopathy - An Updated UNOS Analysis

Introduction The purpose of this analysis is to provide up to date, summary data around post cardiac transplant survival in patients with Adriamycin associated cardiomyopathy (ACM). Hypothesis Post cardiac transplant survival of ACM patients will be the same as other cardiomyopathy subtypes. Methods Adults (≥18 years) who underwent first-time, single organ heart transplantation were identified from the United Network for Organ Sharing (UNOS) between October 18, 2008 and October 18, 2018 (continuous flow LVAD era, prior to UNOS allocation system change). Cardiomyopathy subtypes that could have been supported with an LVAD (ACM, dilated cardiomyopathy (DCM), ischemic cardiomyopathy (ICM)) were included in the analysis. To test the association between cardiomyopathy subtype and post cardiac transplant survival, a multivariate cox regression analysis was performed. Results The analysis included 18,270 patients (357 ACM, 10,662 DCM, 7,251 ICM). ACM heart transplant recipients were younger, had a higher percentage of women, and had higher pulmonary vascular resistance at listing (Table).While rates of bridge to transplant LVAD increased during this time period, the ACM group had a lower percentage of durable LVADs at the time of transplant (Table). Compared with DCM (reference group), patients with ACM did not experience an increase in post cardiac transplant mortality (adjusted HR 1.05, 95% CI 0.8 to 1.4, p = 0.76) or ICM (adjusted HR 1.2, 95% CI 0.9 to 1.6, p = 0.3). Causes of death after cardiac transplantation were not statistically different between groups. Conclusions Adriamycin associated cardiomyopathy patients who were transplanted during this 10 year period had similar post- transplant survival to those with dilated and ischemic cardiomyopathy. Bridge to transplant LVAD use remains lower than other cardiomyopathy subtypes.