Superior 5-Year Survival in Heart Transplant Recipients with Pre-Transplant Dilated Cardiomyopathy Versus Ischemic Cardiomyopathy

Background/Objectives: Because donor-heart availability remains limited, adequate selection of candidates for heart transplantation (HTX) is essential for post-transplant success. Differences in the underlying etiology leading to HTX may play a relevant prognostic role. We compared the post-transplant outcomes of HTX recipients with pre-transplant dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM). Methods: We performed a retrospective single-center observational study of adult patients who underwent HTX at Heidelberg Heart Center between 1998 and 2020 excluding patients with repeat HTX. Patients were stratified according to pre-transplant DCM or ICM etiology. Our analysis comprised donor and recipient data, immunosuppressive therapy, post-transplant concomitant medications, and 5-year post-transplant mortality including causes of death. Results: This study included 158 patients with pre-transplant ICM (40.8%) and 229 patients with pre-transplant DCM (59.2%). HTX recipients with pre-transplant DCM had a significantly lower post-transplant 5-year mortality (27.5% versus 41.1%, p = 0.005). Multivariate analysis including 15 variables indicated a reduced risk of 5-year post-transplant mortality in individuals with pre-transplant DCM (HR: 0.478, 95% CI: 0.235–0.972, p = 0.042). A subgroup analysis of 62 HTX recipients with pre-transplant familial DCM and 167 HTX recipients with pre-transplant idiopathic DCM showed a significantly lower 5-year post-transplant mortality in HTX recipients with pre-transplant familial DCM (14.5% versus 32.3%, p = 0.007). A second multivariate analysis showed a reduced risk of 5-year post-transplant mortality in HTX recipients with pre-transplant familial DCM (HR: 0.380, 95% CI: 0.179–0.807, p = 0.012). Conclusions: HTX recipients with pre-transplant DCM, particularly familial DCM, showed superior 5-year post-transplant survival.