Invasive Hemodynamics and Rejection Rates in Patients With Cardiac Sarcoidosis After Heart Transplantation |
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Authors: | David G Rosenthal Molly E Anderson Bradley J Petek Daniel M Arnett Paco E Bravo Ganesh Raghu Zachary D Goldberger Kristen K Patton Richard K Cheng |
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Affiliation: | 1. Division of Cardiology, University of California, San Francisco, California, USA;2. Department of Medicine, University of California, San Francisco, California, USA;3. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;4. Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA;5. Divisions of Nuclear Medicine and Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA;6. Division of Pulmonology and Critical Care, University of Washington Medical Center, Seattle, Washington, USA |
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Abstract: | BackgroundOrthotopic heart transplant (OHT) is increasingly used for end-stage heart failure due to cardiac sarcoidosis (CS). However, concern regarding long-term outcomes in patients with CS after OHT persists because of multiorgan involvement.MethodsBaseline demographics and invasive hemodynamics were measured in 12 patients with CS and 28 patients with nonischemic cardiomyopathy requiring OHT at the time of transplantation, 1 week after OHT, and in routine follow-up. Primary endpoints included changes in pulmonary artery pressure, right ventricular stroke work index, and pulmonary compliance. Secondary endpoints included degree of allograft rejection and death.ResultsDuring a mean follow-up of 73.8 months, no differences in pulmonary artery pressures, right ventricular stroke work index, or cardiac index were observed in patient with CS (n = 12) compared with those without CS (n = 28) between 1 week after OHT and the most recent follow-up. Long-term follow-up showed that pulmonary hemodynamics remained normal in the CS group. International Society for Heart and Lung Transplantation (ISHLT) 1990 grade ≥ 1a rejection occurred less frequently in the CS group (17% vs 68%, P = 0.006), and 0 of 12 patients in the CS group experienced histologic or clinical recurrence of sarcoidosis or ≥2 rejection. Patients with CS had excellent survival after OHT, with 0 deaths or significant rejection.ConclusionsPatients with CS have similar post-transplant hemodynamics as patients without CS, without evidence of right ventricular dysfunction or pulmonary hypertension. Neither significant rejection nor recurrence of sarcoid in the allograft was observed in this cohort of patients with CS. Survival is similar between patients with CS and those without CS. Heart transplant is a viable strategy in selected patients with CS with excellent outcomes. |
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Keywords: | Corresponding author: Dr David G Rosenthal Division of Cardiology University of California San Francisco 505 Parnassus Avenue San Francisco California 94122 USA Tel : +1-415-353-2873 fax: +1-415-353-2528 |
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