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Transplantation for Myocarditis: A Controversy Revisited

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Myocarditis is a major cause of end-stage heart failure and is responsible for up to 10% of cases of idiopathic dilated cardiomyopathy (IDC). Worldwide, approximately 45% of all heart transplants are performed for IDC and up to 8% for myocarditis. Early reports suggested that survival after transplantation for myocarditis was poor and patients had an increased risk of rejection. More recently, larger case series suggest that overall survival after transplantation for myocarditis is similar to survival after transplantation for other causes. However, certain disorders, including cardiac sarcoidosis and giant cell myocarditis (GCM), require heightened surveillance for post-transplantation disease recurrence. We present the case of a 42-year-old man with recurrence of GCM 8 years after transplantation and review the literature on the role of cardiac transplantation for patients with myocarditis.

Section snippets

Case report

A 42-year-old white man presented with symptoms of progressive shortness of breath and lethargy on exertion for 10-months (New York Heart Association [NYHA] functional class III). He was a non-smoker and had no prior medical history. Transthoracic echocardiogram demonstrated global left ventricular (LV) dysfunction with moderate mitral regurgitation. Heart catheterization revealed normal coronary arteries with severely diminished LV systolic function (ejection fraction, 10%). His right heart

Transplantation for Lymphocytic Myocarditis

Lymphocytic myocarditis is considered an indication for VAD placement or transplantation when congestive heart failure is refractory to medical therapy. The incidence of patients undergoing transplantation for myocarditis ranges from 1% to 8%6, 11; however, the incidence may be greater, as the diagnosis is difficult to secure. The benefits of heart transplantation for myocarditis have been challenged, as the reported risk of death following transplantation appears higher than in the general

Summary

Current data suggest that cardiac transplantation for patients with lymphocytic myocarditis is not associated with an increased risk of allograft rejection or death.

In contrast to lymphocytic myocarditis, the data regarding management and outcome of patients with GCM and cardiac sarcoidosis is limited, and optimal strategies have yet to be determined. Despite an approximate 25% risk of histologic recurrence, overall survival of GCM patients post-transplantation is equivalent to survival after

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