Abstract 17587: Myocarditis is Not an Independent Risk Factor for Outcomes in Children Listed for Heart Transplantation
Introduction: While many children with myocarditis recover, some have persistent heart failure and are listed for heart transplantation (HT). Previous reports suggest worse post-transplant survival in children with myocarditis compared to children with dilated cardiomyopathy (DCM) leading some to theorize that viral/inflammatory factors adversely affect graft survival.
Hypothesis: Among children listed for HT, those with myocarditis have higher wait-list and post-transplant mortality compared to children with DCM; however, these differences are accounted for by differences in baseline risk factors.
Methods: We identified all US children < 18 yrs. of age between 07/04 and 12/10 who were listed for HT with a diagnosis of myocarditis or DCM in the Organ Procurement and Transplant Network database. Cox models were used to determine whether myocarditis is independently associated with wait-list mortality (or becoming too sick to transplant) and post-transplant graft loss (death/re-HT).
Results: Overall, 139 children with myocarditis and 1058 with DCM were analyzed. Children with myocarditis were more likely to be listed as status 1A (81% vs. 71%, P=0.02), on ventilator support (48% vs. 25%, P<0.001), mechanical support (44% vs. 18%, P<0.001) and with renal dysfunction (52% vs. 42%, P<0.01). Children with myocarditis were more likely to die on the wait-list or become too sick to transplant (18% vs. 10%, hazard ratio (HR) 2.0, 95% CI 1.3-3.1). However, in analysis adjusted for age, listing status, ventilator support and renal function at listing, myocarditis was not associated with wait-list mortality (HR 1.4, 95% CI 0.9-2.2, P=0.16). Overall, 86 children with myocarditis and 824 with DCM received HT. Children with myocarditis were at higher risk of graft loss compared to children with DCM (HR 1.8, 95% CI 1.0-3.0). However, in analysis adjusted for age, race, mechanical support and renal function at HT, myocarditis was not associated with risk of graft loss (HR 1.4, 95% CI 0.8-2.4, P=0.27).
Conclusions: Among children listed for HT, those with myocarditis are at higher risk of wait-list and post-transplant mortality compared to children with DCM. However, these differences in outcomes may be explained by their differences in severity of illness at listing/HT.
Author Disclosures: J.C. Garbern: None. K. Gauvreau: None. E.D. Blume: None. T.P. Singh: None.
- © 2014 by American Heart Association, Inc.