Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-08-17 , DOI: 10.1007/s00392-021-01920-0 Emanuele Bobbio 1, 2 , Marie Björkenstam 1, 2 , Niklas Bergh 1, 2 , Kristjan Karason 1, 2, 3 , Entela Bollano 1, 2 , Christian L. Polte 2, 4 , Bright I. Nwaru 5, 6 , Francesco Giallauria 7 , Eva Hessman 8 , Jukka Lehtonen 9
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Heart transplantation (HTx) is a valid therapeutic option for end-stage heart failure secondary to cardiac sarcoidosis (CS) or giant-cell myocarditis (GCM). However, post-HTx outcomes in patients with inflammatory cardiomyopathy (ICM) have been poorly investigated. We searched PubMed, Scopus, Science Citation Index, EMBASE, and Google Scholar, screened the gray literature, and contacted experts in the field. We included studies comparing post-HTx survival, acute cellular rejection, and disease recurrence in patients with and without ICM. Data were synthesized by a random‐effects meta‐analysis. We screened 11,933 articles, of which 14 were considered eligible. In a pooled analysis, post-HTx survival was higher in CS than non-CS patients after 1 year (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.60–1.17; I2 = 0%) and 5 years (RR 0.72, 95% CI 0.52–0.91; I2 = 0%), but statistically significant only after 5 years. During the first-year post-HTx, the risk of acute cellular rejection was similar for patients with and without CS, but after 5 years, it was lower in those with CS (RR 0.38, 95% CI 0.03–0.72; I2 = 0%). No difference in post-HTx survival was observed between patients with and without GCM after 1 year (RR 1.16, 95% CI 0.05–2.28; I2 = 0%) or 5 years (RR 0.98, 95% CI 0.42–1.54; I2 = 0%). During post-HTx follow-up, recurrence of CS and GCM occurred in 5% and 8% of patients, respectively. Post-HTx outcomes in patients with CS and GCM are comparable with cardiac recipients with other heart failure etiologies. Patients with ICM should not be disqualified from HTx.
Graphic abstract
中文翻译：
心脏结节病和巨细胞性心肌炎心脏移植术后短期和长期结果：系统评价和荟萃分析
心脏移植 (HTx) 是继发于心脏结节病 (CS) 或巨细胞心肌炎 (GCM) 的终末期心力衰竭的有效治疗选择。然而，对炎症性心肌病 (ICM) 患者的 HTx 后结果的研究很少。我们检索了 PubMed、Scopus、Science Citation Index、EMBASE 和 Google Scholar，筛选了灰色文献，并联系了该领域的专家。我们纳入了比较有和无 ICM 患者的 HTx 后存活率、急性细胞排斥反应和疾病复发的研究。数据通过随机效应荟萃分析合成。我们筛选了 11,933 篇文章，其中 14 篇被认为符合条件。在一项汇总分析中，1 年后，CS 患者的 HTx 后生存率高于非 CS 患者（风险比 [RR] 0.88，95% 置信区间 [CI] 0.60-1.17；I2 = 0%）和 5 年（RR 0.72，95% CI 0.52–0.91；I 2 = 0%），但仅在 5 年后才具有统计学意义。在 HTx 后的第一年，有和没有 CS 的患者发生急性细胞排斥的风险相似，但 5 年后，有 CS 的患者发生急性细胞排斥反应的风险较低（RR 0.38，95% CI 0.03–0.72；I 2 = 0%）。在 1 年（RR 1.16，95% CI 0.05–2.28；I 2 = 0%）或 5 年后（RR 0.98，95% CI 0.42–1.54；I 2 = 0%）。在 HTx 后随访期间，分别有 5% 和 8% 的患者出现 CS 和 GCM 复发。CS 和 GCM 患者的 HTx 后结果与其他心力衰竭病因的心脏受者相当。ICM 患者不应被取消 HTx 的资格。
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