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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Life on the driveline: Still finding traction in improving transplant outcomes for children with myocarditis

  • Ryan L. Kobayashi
    Correspondence
    Reprint requests: Ryan L. Kobayashi, Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA 02115. Phone: 617-355-6329 | Fax: 617-734-9930.
    Affiliations
    Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Christina J. VanderPluym
    Affiliations
    Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
Published:October 09, 2022DOI:https://doi.org/10.1016/j.healun.2022.09.019
      In this edition of The Journal of Heart and Lung Transplantation, Amdani et al.
      • Amdani S.
      • Korang A.A.
      • Law Y.M.
      • et al.
      Waitlist and post-transplant outcomes for children with myocarditis listed for heart transplantation over three decades.
      compare waitlist and postheart transplant (HT) outcomes for children with myocarditis with those with dilated cardiomyopathy (DCM) in both the modern (2009-2019) and previous (1993-2008) eras. The authors describe the concerning lack of improvement in waitlist or post-HT outcomes among myocarditis patients over this 30 year study period. They find that compared with children with DCM, those with myocarditis are more ill at listing and time of transplant with more frequent use of mechanical circulatory support. Children with myocarditis are less likely to be transplanted at 6 and 12-months postlisting with higher likelihood to be removed from the waitlist for recovery (19%) and death (12% at 12 months). Despite this, on multiphase parametric analysis, Amdani et al find myocarditis is not an independent risk factor for waitlist mortality. Possibly attributable to higher levels of critical illness in the myocarditis cohort at time of transplant, the risk of early (within 1 year) post-HT graft loss is higher in the myocarditis group (HR 2.46), however, in the constant phase (>1 year post-HT), there is no difference in graft loss between the myocarditis and DCM groups. Lastly, the authors note that ventricular assist device (VAD) support at transplant is a risk factor for graft loss in the constant phase as is recipient Black race.
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