438 Cardiac Transplantation for Chemotherapy Induced Cardiomyopathy: Demographics and Long Term Follow-Up

Purpose: Chemotherapy-induced cardiomyopathy (CIC) is increasing in prevalence due to increased cancer survival. Late onset severe cardiac functional impairment after cure of cancer allows consideration for heart transplantation (HT). Methods and Materials: A retrospective analysis of 980 patients from our heart failure clinic was performed. Patient demographics were collated and patients with CIC were evaluated in relation to their subsequent need for HT and long term follow up. Results: 16/980 (1.6%) patients were diagnosed with CIC and HT required in 6 (38%). Mean age at presentation with CIC was 32.3 years (range 8 – 63). Mean age of CIC presentation for HT recipients was 22.3 (range 8 – 25). Overall cancer diagnosis: Ewing’s sarcoma (5), Osteosarcoma (2), lymphoma (5), Wilm’s tumour (2), breast cancer (1) and 1 patient lymphoma followed 8 years later by sarcoma with subsequent cardiomyopathy. All CIC patients had been treated with Anthracyclines. Cyclophophamide was used in 3 and Cisplatin in 2. Rate of HT by diagnosis: Ewing’ Sarcoma (60%), osteosarcoma (50%) and lymphoma (20%), no other malignancy diagnoses were transplanted. 44% of overall CIC but no HT recipient received chest radiotherapy. Mean interval cancer treatment to cardiomyopathy was 12.8 years. Mean time CIC diagnosis to transplant 6 years (range 0 – 11). Overall mortality was 19%. One death occurred 9 months post HT from rejection. At a mean of 6 years post HT (range 0 – 10) there have been no cases of recurrent malignancy. Conclusions: Chemotherapy-induced cardiomyopathy typically presents late and predominantly affects young patients post lymphoma or sarcoma treated with anthracyclines. The rate of need for HT in CIC is high although this may be reflective of referral bias. Patients who subsequently undergo HT are younger but with judicious selection have a low risk of recurrence.