Heart Transplantation Outcomes in Adults with Postpartum Cardiomyopathy

Abstract

Postpartum cardiomyopathy (PPCM) is a prevalent cause of end-stage heart failure in women, from which about 10% will require heart transplantation. We aimed to further evaluate long-term heart transplant (HT) outcomes in this cohort of patients and compare them to all other heart transplant recipients. The UNOS registry was queried for all cardiac transplants in the registry from 1987 to 2019 to compare characteristics and outcomes for PPCM-patients and all other HT patients. Hazard ratios (HR) were calculated using multivariate Cox proportional hazard regression analysis. Survival curves were generated with the Kaplan Meier method. Between 1987 and 2019, 63,142 patients received a heart transplant. Of these patients, 666 women had a heart transplant in which the indication was PPCM. These patients tended to be younger (p<0.001), less likely to have diabetes (p<0.001), and less likely to smoke (p<0.001). About 48% of all PPCM patients requiring HT were African American. PPCM-patients were more likely to have required prior cardiac surgery (p<0.001) and higher frequency of support pre-transplant (p<0.001), including intra-aortic balloon pump (IABP) (p=0.006), ventricular assist device (VAD) (p < 0.001) but not extracorporeal membrane oxygenation (ECMO) (p=0.47). PPCM patients had fewer median days on the wait list prior to heart transplant (57.5 vs 83.0 days, p<0.001). In the PPCM group, there was significantly greater incidence of pre-transplant panel reactive antibodies > 20% (22.2% vs. 9.4%, p<0.001). The overall post-transplant survival was significantly lower in the PPCM group (Figure, p<0.001). Despite being a younger cohort with less chronic medical issues, PPCM had worse survival compared to non-PPCM patients with increased sensitization as well as increased use of IABP and VAD support. Further study is warranted to address these findings.