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Meta-Analysis
. 2022 Feb;111(2):125-140.
doi: 10.1007/s00392-021-01920-0. Epub 2021 Aug 17.

Short- and long-term outcomes after heart transplantation in cardiac sarcoidosis and giant-cell myocarditis: a systematic review and meta-analysis

Emanuele Bobbio  1   2 , Marie Björkenstam  1   2 , Bright I Nwaru  3   4 , Francesco Giallauria  5 , Eva Hessman  6 , Niklas Bergh  1   2 , Christian L Polte  2   7 , Jukka Lehtonen  8 , Kristjan Karason  1   2   9 , Entela Bollano  10   11
Affiliations
Meta-Analysis

Short- and long-term outcomes after heart transplantation in cardiac sarcoidosis and giant-cell myocarditis: a systematic review and meta-analysis

Emanuele Bobbio et al. Clin Res Cardiol. 2022 Feb.

Abstract

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.

Keywords: Cardiac sarcoidosis; Giant-cell myocarditis; Heart transplantation; Inflammatory cardiomyopathy; Meta-analysis; Systematic review.

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Conflict of interest statement

None of the authors has any conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of studies on the outcomes of patients who underwent HTx because of either CS or GCM
Fig. 2
Fig. 2
Risk of post-HTx death in patients with and without CS after 1, 5, and 10 years of follow-up
Fig. 3
Fig. 3
Risk of post-HTx death in patients with and without GCM after 1 and 5 years of follow-up
Fig. 4
Fig. 4
Risk of acute cellular rejection in patients who underwent HTx due to CS versus other HF etiologies after 1 and 5 years of follow-up
Fig. 5
Fig. 5
Risk of acute cellular rejection in patients who underwent HTx due to GCM versus other HF etiologies after 1 and 5 years of follow-up
See this image and copyright information in PMC

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