title: Heart transplant survival outcomes for adriamycin-dilated cardiomyopathy.
abstract: In 2015, there will be an estimated 11.3 million cancer survivors. With an increasing population of cancer survivors, it is imperative to understand the treatment options available and outcomes for chemotherapy-related cardiomyopathy. Anthracycline-based chemotherapy causes heart failure in approximately 5% of patients. Orthotopic heart transplantation (OHT) is an option for cancer survivors in complete remission who develop end-stage heart failure. We examined retrospective OHT data collected from the United Network of Organ Sharing from 1987 to 2011. The primary aim was to characterize the survival in patients with either the primary diagnosis of "dilated cardiomyopathy: Adriamycin" (DCA) versus "all other" causes of cardiomyopathy. The secondary aim was to define the differences in the primary cause of death and to describe the temporal relationship of DCA OHT. The United Network of Organ Sharing database identified 453 OHTs for the diagnosis of DCA and 51,312 OHTs for all other causes of cardiomyopathy. The DCA group was significantly younger with a greater percentage of women. After adjusting for age, gender, and history of malignancy, the 10-year survival curves showed that patients with DCA have an improved survival compared to those with all other causes of cardiomyopathy (hazard ratio 1.28, p = 0.026). No difference was found in the primary cause of death between the 2 groups. A statistically significant increasing temporal trend was seen in the number of OHTs for the diagnosis DCA. In conclusion, patients who undergo OHT for DCA have favorable 10-year survival, making OHT a good therapeutic option for end-stage heart failure due to anthracyclines. Additionally, no increased risk of cancer-related deaths was found in the DCA group, demonstrating that recurrent malignancy does not affect long-term survival. The temporal trends demonstrated that DCA remains a significant problem for cancer survivors.
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lenneman
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Mark
authors.initials: M
authors.lastname: Wigger
authors.forename: Haydar
authors.initials: H
authors.lastname: Frangoul
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.forename: Cheri
authors.initials: C
authors.lastname: Silverstein
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Sawyer
authors.forename: Carrie G
authors.initials: CG
authors.lastname: Lenneman
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000139:chemically induced / Q000401:mortality / Q000601:surgery*; D004317:Doxorubicin / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D004317:Doxorubicin