Abstract 2964: Outcomes in Patients with Adriamycin Cardiotoxicity Undergoing Orthotopic Heart Transplantation: An Analysis of the United Network for Organ Sharing Database
Background: Anthracyclines are the mainstay of breast cancer, leukemia, lymphoma and sarcoma treatment. Since approval of doxorubicin (adriamycin), the first and most widely used anthracycline, in 1974, cardiac toxicity has been the major complication of use of these drugs. Although orthotopic heart transplant (OHT) is considered an option for cancer survivors in complete remission, to our knowledge, the outcomes of OHT in these patients have not been reported.
Methods: We reviewed the United Network for Organ Sharing (UNOS) database to identify transplants performed from 1988 through 2007. Individuals were stratified between a primary diagnosis of Dilated Myopathy: Adriamycin (DMA) and all other diagnoses. Survival rates at 1, 12, 36, 60 and 120 months post-transplant and proportions of deaths due to malignancy and rejection were reviewed.
Results: From 1988 to 2007, 68,863 persons were listed with UNOS. Of those, 487 (0.71%) had a primary diagnosis of DMA. In the same period, 43,113 persons received OHT. Of those, 328 (0.76%) had a primary diagnosis of DMA. The DMA group had a younger mean age (37.6 vs. 45.9) and a higher fraction of females (199/328 (60.67% [55.38 – 65.96]) vs. 10447/42785 (24.42% [24.01–24.83]); (z = 15.2, p < 0.001)) than all others. Survival at all time points was equivalent in DMA and all others (1mo: 94.12% [91.17–97.07] vs. 92.98% [92.74 –93.23]; 12mo: 86.53% [82.40 –90.66] vs. 84.79% [84.45–85.14]; 36mo: 78.31% [73.21– 83.42] vs. 77.37% [76.95–77.78]; 60mo: 69.73% [63.78 –75.69] vs. 70.53% [70.06 –71.00]; 120mo: 55.32% [48.03– 62.62] vs. 51.06% [50.44 –51.67]). Malignancy was reported as the primary cause of death in a similar portion of patients in both groups (10/115 (8.7% [3.55–13.85]) vs. 1901/17819 (10.67% [10.22–11.12]); (z = −0.682, p = 0.496)). Rejection was reported as a primary cause of death in a higher fraction of DMA patients (19/115 (16.52% [9.73–23.31]) vs. 1860/17819 (10.44% [9.99 –10.89]); (z = 2.12, p < 0.05)).
Conclusions: Individuals with cardiomyopathy due to anthracycline cardiotoxicity are not higher risk candidates for OHT. The cause of the higher fraction of reported deaths due to rejection in DMA patients is likely multifactorial, including the younger mean age and higher fraction of females in this group.
This research has received full or partial funding support from the American Heart Association, AHA National Center.