Adults with chemotherapy-induced dilated cardiomyopathy demonstrated superior post-transplant survival compared to non-ischemic dilated cardiomyopathy (HR 0.78), while pediatric survival was comparable.
Cohort (n=28,813)
Yes
Does heart transplantation for chemotherapy-induced dilated cardiomyopathy result in comparable post-transplant outcomes compared to non-ischemic dilated cardiomyopathy?
Heart transplantation in patients with chemotherapy-induced dilated cardiomyopathy achieves survival and safety outcomes comparable to or better than those with non-ischemic dilated cardiomyopathy.
Effect estimate: HR 0.78 (95% CI 0.64-0.96)
Absolute Event Rate: 68% vs 59%
p-value: p=0.018
Background: Chemotherapy-induced dilated cardiomyopathy (CIDCM) has become an increasingly recognized indication for heart transplantation (HT) among cancer survivors with end-stage heart failure (HF). Advances in cardio-oncology practices, mechanical circulatory support, and refined immunosuppression strategies have improved outcomes; however, comparative data with non-ischemic dilated cardiomyopathy (NIDCM) in the modern ventricular assist device (VAD) era remain limited. Therefore, this study primarily aimed to compare post-transplant outcomes between CIDCM and NIDCM within pediatric and adult cohorts in the VAD era. Methods: Data from the United Network for Organ Sharing (UNOS) registry were used to retrospectively analyze first-time orthotopic HT recipients between January 2010 and March 2023, with follow-up through March 2024. CIDCM was defined using the UNOS diagnosis codes “dilated myopathy-adriamycin” or “dilated myopathy-cancer”, whereas NIDCM included idiopathic, familial, myocarditis-related, and other specific DCM subtypes. Primary outcomes were post-HT survival, treated allograft rejection, and new or recurrent malignancy. Results: Among 28,813 recipients, 527 had CIDCM (52 pediatric, 475 adults). Pediatric survival was comparable between groups (1-, 5-, and 10-year survival: 0.92, 0.86, 0.76 vs. 0.95, 0.82, 0.68; p = 0.951). Adults with CIDCM showed superior survival (0.92, 0.82, and 0.68 vs. 0.91, 0.79, and 0.59; p = 0.018; hazard ratio (HR) 0.78 (0.64–0.96)) and lower rejection rates (0.03 vs. 0.04 events/person-year; p = 0.0027), with similar incidence of post-HT malignancy. Older age, female sex, and minority race were associated with reduced survival. In pediatric recipients, age >10 years and Ebstein Bar Virus (EBV) seronegativity were associated with post-HT malignancy; in adults, age ≥50 years was predictive. Conclusions: HT in CIDCM achieves durable survival and safety comparable to NIDCM. These results support expanding HT eligibility and multidisciplinary evaluation for cancer survivors with advanced HF in the contemporary era.
Das et al. (2026) conducted a cohort in Chemotherapy-induced dilated cardiomyopathy vs Non-ischemic dilated cardiomyopathy (n=28,813). Heart transplantation for chemotherapy-induced dilated cardiomyopathy vs. Heart transplantation for non-ischemic dilated cardiomyopathy was evaluated on 10-year post-transplant survival in adults (HR 0.78, 95% CI 0.64-0.96, p=0.018). Adults with chemotherapy-induced dilated cardiomyopathy demonstrated superior post-transplant survival compared to non-ischemic dilated cardiomyopathy (HR 0.78), while pediatric survival was comparable.