Mediastinal radiation and adverse outcomes after heart transplantation.
Orthotopic heart transplantation (OHT) may represent the only treatment option for patients with end-stage cardiovascular disease due to mediastinal radiation therapy (MRT). The primary aim of this study was to evaluate the safety and efficacy of OHT in this patient population. We conducted a retrospective, single-center cohort study of patients with MRT-associated cardiovascular disease who underwent OHT between January 1987 and September 2008. Nine patients (3 men), aged 46 +/- 11 years at the time of their OHT, were identified. Time from MRT to OHT was 26 +/- 11 years. Lymphoma was the indication for MRT in all patients. Five patients had non-ischemic dilated cardiomyopathy, 2 had ischemic cardiomyopathy and 2 had constrictive pericarditis. Three patients expired in the peri-operative period, whereas another patient died 3 years post-transplant from lung carcinoma. Two additional patients developed a secondary malignancy post-transplant. Five patients are still alive at a mean follow-up of 10 +/- 8 years. Early survival rate is poor in patients who undergo OHT for MRT-associated end-stage cardiovascular disease. In addition, long-term follow-up shows an elevated incidence of malignancies. Our results raise concern about the safety and efficacy of performing OHT in patients with MRT-associated cardiovascular disease.
Uriel
Nir
N
Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Vainrib
Alan
A
Jorde
Ulrich P
UP
Cotarlan
Vlad
V
Farr
Maryjane
M
Cheema
Faisal H
FH
Naka
Yoshifuma
Y
Mancini
Donna
D
Colombo
Paolo C
PC
D000328:Adult; D001706:Biopsy; D009202:Cardiomyopathies / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000532:radiotherapy*; D008297:Male; D008482:Mediastinum / Q000528:radiation effects*; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011832:Radiation Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome