Graft survival after cardiac transplantation for alcohol cardiomyopathy.
BACKGROUND
Alcohol cardiomyopathy (ACM) constitutes up to 40% of patients with non-ischemic dilated cardiomyopathy. Transplant-free survival is worse for patients with ACM versus idiopathic dilated cardiomyopathy (IDCM) with continued exposure. The prognosis for patients with ACM after cardiac transplantation is unknown.


METHODS
We evaluated adults who underwent single-organ, cardiac transplantation from 1994 to 2009 with a diagnosis of ACM (n=134) or IDCM (n=10,243) in the Organ Procurement Transplantation Network registry. Kaplan-Meier curves were generated by cohort for time until graft failure, cardiac allograft vasculopathy, and hospitalization for rejection. A Cox proportional hazards model was created to determine factors associated with each outcome.


RESULTS
Patients with ACM were more likely to be males (P<0.0001), minorities (P<0.0001), and smokers (P=0.0310) compared with IDCM. Overall graft survival was lower for the ACM cohort (P=0.0001). After multivariate analysis, ACM was not independently associated with graft survival (HR 1.341, 95% CI 0.944-1.906, P=0.1017). Creatinine, total bilirubin, minority ethnicity, graft under-sizing, life support, diabetes, and donor age were independent predictors of graft failure. There were no significant differences between primary cause of death, vasculopathy, or rejection.


CONCLUSIONS
There was no association between ACM and graft survival in this large registry study, but poorer overall survival in the ACM cohort was associated with other recipient characteristics.
1 Division of Cardiovascular Disease, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 2 Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 3 Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY. 4 Address correspondence to: D. Marshall Brinkley, M.D., Division of Cardiovascular Disease, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, West Campus, Baker 4, Boston, MA 02215.
D Marshall
DM
Brinkley
Eric
E
Novak
Veli K
VK
Topkara
Edward M
EM
Geltman
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications*; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models