Nationwide Outcomes of Heart Transplantation for Postpartum Cardiomyopathy.

BACKGROUND

Postpartum cardiomyopathy is defined as an incident of acute heart failure in the postpartum period in the absence of any other cause. Up to 10% of postpartum cardiomyopathy may need to undergo heart transplantation later in life. This study aimed to provide a present-day perspective on all-cause mortality and transplant-related complications after heart transplantation for postpartum cardiomyopathy.

METHODS

A retrospective analysis of the United Network for Organ Sharing (UNOS) registry was performed for adult patients undergoing heart transplants (01/2001-01/2023) for postpartum cardiomyopathy.

RESULTS

A total of 677 patients were identified, with a mean age of 35 years. The mean body mass index (BMI) was 27.2 kg/m2; the most common comorbidity was type 2 diabetes (T2D) (n = 589; 87%). Older age was associated with lower overall mortality (hazard ratio (HR): 0.97; 95% CI: 0.95, 0.98; p < 0.01), while diabetes (HR: 1.01; 95% CI: 1.01, 1.01; p < 0.01), dialysis (HR: 1.01; 95% CI: 1.01, 1.01; p < 0.01), days on Status 1 on the UNOS registry (HR: 1.06; 95% CI: 1.03, 10.9; p < 0.01), creatinine (HR: 1.29; 95% CI: 1.02, 1.64; p = 0.034), and length of stay (HR: 1.01; 95% CI: 1.01, 1.02; p = 0.02) were associated with a higher risk of overall mortality. Moreover, 30-day mortality was 2.8%, and 1-year mortality was 11.1%. The era effect was prominent in cases of 1-year mortality (odds ratio (OR): 0.95; 95% CI: 0.91, 0.99, p = 0.006).

CONCLUSIONS

Our results suggest that younger age, diabetes, pretransplant dialysis, days on Status 1, and creatinine are associated with higher mortality, while an era effect was observed for 1-year mortality after heart transplantation (HTx) in patients with postpartum cardiomyopathy.