Clinical Outcomes Of Patients With Peripartum Cardiomyopathy Listed For Heart Transplantation.

Background In patients with peripartum cardiomyopathy (PPCMP) who do not recover but advance to end-stage heart failure, treatment with heart transplantation (HT) or a durable left ventricular assist device (LVAD) as a bridge to HT is an alternative. We describe the characteristics and clinical outcomes of PPCMP patients listed for HT from a national registry. Methods The United Network for Organ Sharing database was used to identify end-stage HF patients with PPCMP as the etiology of HF who were listed for HT between 2008 and 2020. Baseline clinical characteristics were compared between those listed with or without an LVAD. The primary outcome was waitlist mortality evaluated with competing risk analysis for death, transplant, or recovery. Post-transplant survival at 5-years was compared between both groups with Kaplan Meier survival curves in HT candidates. Cox proportional Hazard modelling was used to identify independent predictors of 5-year post-transplant survival. Results A total of 620 PPCMP patients (Non-LVAD; n=390; LVAD: n=230) were listed for HT during the study period. Of these 379 (68%) successfully reached HT, 66 (11%) died or were delisted due to deteriorating clinical status and 40 (7%) recovered while on the waitlist. Compared to Non-LVAD patients, LVAD candidates were younger (median age: 36 vs. 33 years, p=0.02), had a higher BMI (29 vs. 27 kg/m2, p=0.01) and more likely ≤ high school graduates (55% vs. 44%; p=0.01). Waitlist mortality at 1-year after listing was similar in both groups. (Non-LVAD vs. LVAD; 11.6% vs. 9.5%; Fine-Gray test: p=0.53) (Figure A) with no difference in 5-year post-transplant survival. [Log rank test: p =0.72]. (Figure B). On Cox proportional hazard modelling, level of education (≥ College) HR: 95% C.I [1.5 (1.1, 2.2; p=0.01)] was associated with 5-year post-transplant survival. Conclusions About two-thirds of PPCMP patients who were listed for HT were successfully transplanted, despite a low rate of myocardial recovery. Waitlist mortality at 1 year and 5-year post-transplant survival was comparable regardless of treatment approach. In patients with peripartum cardiomyopathy (PPCMP) who do not recover but advance to end-stage heart failure, treatment with heart transplantation (HT) or a durable left ventricular assist device (LVAD) as a bridge to HT is an alternative. We describe the characteristics and clinical outcomes of PPCMP patients listed for HT from a national registry. The United Network for Organ Sharing database was used to identify end-stage HF patients with PPCMP as the etiology of HF who were listed for HT between 2008 and 2020. Baseline clinical characteristics were compared between those listed with or without an LVAD. The primary outcome was waitlist mortality evaluated with competing risk analysis for death, transplant, or recovery. Post-transplant survival at 5-years was compared between both groups with Kaplan Meier survival curves in HT candidates. Cox proportional Hazard modelling was used to identify independent predictors of 5-year post-transplant survival. A total of 620 PPCMP patients (Non-LVAD; n=390; LVAD: n=230) were listed for HT during the study period. Of these 379 (68%) successfully reached HT, 66 (11%) died or were delisted due to deteriorating clinical status and 40 (7%) recovered while on the waitlist. Compared to Non-LVAD patients, LVAD candidates were younger (median age: 36 vs. 33 years, p=0.02), had a higher BMI (29 vs. 27 kg/m2, p=0.01) and more likely ≤ high school graduates (55% vs. 44%; p=0.01). Waitlist mortality at 1-year after listing was similar in both groups. (Non-LVAD vs. LVAD; 11.6% vs. 9.5%; Fine-Gray test: p=0.53) (Figure A) with no difference in 5-year post-transplant survival. [Log rank test: p =0.72]. (Figure B). On Cox proportional hazard modelling, level of education (≥ College) HR: 95% C.I [1.5 (1.1, 2.2; p=0.01)] was associated with 5-year post-transplant survival. About two-thirds of PPCMP patients who were listed for HT were successfully transplanted, despite a low rate of myocardial recovery. Waitlist mortality at 1 year and 5-year post-transplant survival was comparable regardless of treatment approach.