Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Pramod Bonde

Abstract

In this analysis, we examine a large national cohort within the Organ Procurement and Transplantation Network’s (OPTN) United Network for Organ Sharing (UNOS) database for the purpose of determining the impact of a recipient history of myocarditis as well as donor/recipient ABO compatibility on outcomes following heart transplantation. We used a nationwide sample with primary stratification between ABO identical and compatible heart transplantations or transplant recipients diagnosed with myocarditis and those diagnosed with ischemic or idiopathic cardiomyopathy. The primary end-point was graft failure from all causes. Post-transplant survival was compared between groups using univariate Kaplan-Meier as well as multivariate Cox proportional hazard and logistic regression models. ABO compatible recipients were generally sicker than ABO identical recipients before transplant as a larger proportion were Status 1A, in the ICU, and on mechanical ventilatory support (p < 0.05). Multivariate analysis did not demonstrate adverse outcomes associated with ABO compatible transplants in terms of decreased graft survival (hazard ratio 0.99, p = 0.87). Blood type O donor grafts, however, were associated with poorer outcomes compared with all other types (p < 0.05), which has important implications for current graft allocation policies. For recipients with a history of myocarditis, survival was comparable with ischemic or idiopathic cardiomyopathy. Patients with myocarditis were more likely to be female, younger, in the ICU before transplant, and on ECMO, ventilatory support, and VAD pre-transplant (p < 0.05). Transplant recipients diagnosed with myocarditis were more likely to die from acute (p < 0.05) and chronic graft failure (p < 0.05). Strategies to safely bridge these patients to transplant such as mechanical circulatory support should be considered earlier in the disease. Furthermore, this analysis suggests that post-transplant outcomes

of patients with a history of myocarditis could be improved with more intensive immunosuppression.

Comments

This is an Open Access Thesis.

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