Heart Transplant Outcomes in Patients with Alcoholic Cardiomyopathy

Abstract

We sought to better characterize differences in transplant outcomes between patients with alcoholic cardiomyopathy and those with other forms of cardiomyopathy in a national cohort. 63,142 OHT recipients were identified from UNOS (1987-2019) of which 224 had alcoholic cardiomyopathy as indication for HT. Multivariate Cox proportional hazard regression analysis was adjusted for age, sex, DM2, ethnicity, ischemic time, dialysis, life support, waitlist time and HLA mismatch. Kaplan-Meier survival curves were generated comparing survival outcomes in patients with alcoholic cardiomyopathy vs. patients with non-alcoholic cardiomyopathy post-OHT, including ischemic, restrictive, dilated, hypertrophic and other. The alcoholic cardiomyopathy group had 224 patients and the non-alcoholic cardiomyopathy group had 62,918 patients. Both cohorts were similar in age, diabetes, smoking status, ischemic time, and need for mechanical support prior to HT. The alcoholic cardiomyopathy cohort was more likely to be male (p<0.001), Black or Hispanic (p<0.001), and history of prior cardiac surgery (p<0.001). No difference in waitlist time was observed. The alcoholic cardiomyopathy cohort had a PRA greater than 20% (p=0.004) and was more likely to die of cardiovascular causes (p=0.005). Overall survival (1, 5, 10 years) was alcoholic cardiomyopathy (85, 67, 47%), non-alcoholic cardiomyopathy (87, 73, 54%) (log rank p=0.0105). 12-year survival for alcoholic cardiomyopathy patients was worse than any other type of cardiomyopathy group (Figure). Post-HT Survival was the lowest in the alcoholic cardiomyopathy cohort compared to post-HT outcomes for all other types of cardiomyopathies. Patient with alcoholic cardiomyopathy tended to have greater sensitization and prior cardiac surgery, however further study is warranted to further delineate factors contributing to this impaired survival.