BACKGROUND

There is limited and conflicting information on waitlist and transplant outcomes for children with myocarditis.

METHODS

Retrospective review included children with myocarditis and dilated cardiomyopathy (DCM) listed for HT from January 01, 1993 to December 31, 2019 in the Pediatric Heart Transplant Society database. Clinical characteristics, waitlist and post-HT outcomes (graft loss, rejection, cardiac allograft vasculopathy, infection and malignancy) for children listed from early (1993-2008) and current era (2009-2019) with myocarditis were evaluated and compared to those with DCM.

RESULTS

Of 9755 children listed, 322 (3.3%) had myocarditis and 3178 (32.6%) DCM. Compared to DCM, children with myocarditis in the early and the current era were significantly more likely to be listed at higher urgency; be in intensive care unit; on mechanical ventilation; extracorporeal membrane oxygenation and ventricular assist device (p < 0.05 for all). While unadjusted analysis revealed lower transplant rates and higher waitlist mortality for children with myocarditis, in multivariable analysis, myocarditis was not a risk factor for waitlist mortality. Myocarditis, however, was a significant risk factor for early phase post-HT graft loss (HR 2.46; p = 0.003). Waitlist and post-HT survival for children with myocarditis were similar for those listed and transplanted in the early era to those listed and transplanted in the current era (p > 0.05 for both).

CONCLUSIONS

Children with myocarditis have a higher acuity of illness at listing and at HT and have inferior post-HT survival compared to children with DCM. Outcomes for children with myocarditis have not improved over the 3 decades and efforts are needed to improve outcomes for this cohort.

中文翻译：

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超过 3 年被列为心脏移植的心肌炎儿童的候补名单和移植后结果

背景

关于心肌炎儿童的候补名单和移植结果的信息有限且相互矛盾。

方法

回顾性研究纳入了 1993 年 1 月 1 日至 2019 年 12 月 31 日期间在儿科心脏移植协会数据库中因 HT 列出的患有心肌炎和扩张型心肌病 (DCM) 的儿童。评估了早期（1993-2008 年）和当前时代（2009-2019 年）患有心肌炎的儿童的临床特征、候补名单和 HT 后结果（移植物丢失、排斥、心脏同种异体移植物血管病变、感染和恶性肿瘤），并与患有心肌炎的儿童进行了比较DCM。

结果

在列出的 9755 名儿童中，322 名 (3.3%) 患有心肌炎，3178 名 (32.6%) 患有扩张型心肌病。与扩张型心肌病相比，早期和当今时代的心肌炎患儿更可能被列为更高的紧急程度；在重症监护病房；关于机械通气；体外膜氧合和心室辅助装置（所有p < 0.05）。虽然未经调整的分析显示患有心肌炎的儿童的移植率较低且等待名单死亡率较高，但在多变量分析中，心肌炎并不是等待名单死亡率的危险因素。然而，心肌炎是早期 HT 移植物丢失的重要危险因素（HR 2.46；p = 0.003）。早期上市和移植的心肌炎儿童的候补名单和 HT 后存活率与当前时代上市和移植的患者相似（两者p > 0.05）。

结论

与患有扩张型心肌病的儿童相比，患有心肌炎的儿童在入院时和在 HT 时疾病的严重程度更高，并且 HT 后的存活率较差。在过去的 3 年中，患有心肌炎的儿童的预后没有改善，需要努力改善该队列的预后。