OUTCOME IN PERIPARTUM CARDIOMYOPATHY AFTER HEART-TRANSPLANTATION

From 1983 to 1991, 27 women with peripartum cardiomyopathy were consid ered for heart transplantation. Of 27 patients, 11 (41%) improved with medical therapy, 10 (37%) underwent transplantation, and six (22%) di ed. Results in the 10 patients with peripartum cardiomyopathy who unde rwent transplantation were compared with results in 39 women who under went transplantation for dilated cardiomyopathy (idiopathic, Adriamyci n, valvular, or familial) to determine whether there were differences in survival, rejection, or infection rates. The two groups were, by ch ance, well matched for number of pregnancies, peak panel reactivity, a nd cross-match. Mean time from delivery to transplantation was 24 week s (range 2 to 188 weeks), and this time did not correlate with rejecti on rates. The linearized rate of rejection from 0 to 3 months was 30% higher in the group with peripartum cardiomyopathy (3.4 +/- 0.7 vs 2.6 +/- 0.3 episodes/100 patient days; p = 0.05). The mean postoperative day to first rejection was day 26 for peripartum cardiomyopathy and da y 28 for women with dilated cardiomyopathy. Rejection requiring cytoly tic therapy occurred in 40% of women with peripartum cardiomyopathy an d 21% of the comparison group (difference not significant). Linearized (treated) infection rates were 1.8 +/- 0.5 for the group with peripar tum cardiomyopathy versus 1.5 +/- 0.2 episodes/100 patient days for ot hers (p = 0.05). Actuarial survival was excellent in both groups with 88% and 86% 2-years survival rates, respectively. In conclusion, women who undergo transplantation for peripartum cardiomyopathy have a 30% higher rate of early rejection than do those who undergo transplantati on for idiopathic cardiomyopathy and tend to have a greater need for c ytolytic therapy. Infection rates are consequently higher. Their survi val, however, is excellent, and they remain a group of young patients highly suited to transplantation.