Introduction
Frailty status affects outcomes after heart transplantation, but the optimal way to assess frailty prior to transplant remains unknown.
Methods
This single‐center, observational study assessed 44 heart transplant candidates for frailty using three methods. The Short Physical Performance Battery (SPPB) and Fried Frailty Phenotype (FFP) were used as two physical assessments of frailty. The Frailty Risk Score (FRS) was used as a chart‐review based assessment measuring 20 different biopsychosocial and functional components, including biomarkers, depression, cognitive impairment, and sleep.
Results
We determined the correlation between FRS, SPPB, and FFP and how each correlated with clinical outcomes. Of 44 participants, mean age was 60 years. FRS correlated with SPPB and FFP (P = .043, P < .001, respectively). Higher frailty as measured by SPPB and FRS was significantly associated with lack of achieving waitlist status (P = .022; P = .002) and not being transplanted (P = .026; P = .008). Higher frailty by SPPB and FFP was also associated with mortality (P = .010; P = .025).
Conclusion
SPPB and chart‐review FRS showed potential for predicting waitlist and transplant status of heart transplant candidates, while SPPB and FFP were associated with mortality. Additional studies may serve to validate these observations.
Purpose: Systemic lupus erythematosus (SLE) is a systemic disease and is commonly considered a contraindication for cardiac transplantation. Meanwhile, lupus myocarditis can present with severe left ventricular dysfunction which my progress to cardiogenic shock with a fatal outcome. Heart transplantation is rarely considered a treatment option, due to 1) multi-organ involvement, and 2) possibility of recurrence of lupus in the transplanted heart. We summarized published cases of cardiac transplantation in SLE. Methods: Two investigators independently searched PubMed, Ovid/Medline, and Google Scholar using terms "heart transplantation", "cardiac transplantation" AND "lupus", "systemic lupus erythematosus", and "lupus myocarditis" for papers published in English in 1988-2020. We then manually searched the references in relevant articles. We included all cases of adult patients where individual patient data were present. Results: We identified 11 cases, six males, and five females, mean age 28 +/-5.47 years. Six of the patients were male and five were female. While all patients had SLE, the most common indication for transplant was pulmonary hypertension (6), followed by lupus myocarditis (2), dilated cardiomyopathy (2), and infective endocarditis (1). In 6 patients there was a dual organ (heart/lung) transplantation, while in five the heart was the only transplanted organ. Two patients died within 2 months post transplant from bowel infarction, and one died in one year from rejection. Remaining eight patients were alive and well after a follow-up ranging nine months to four years, mean 26 +/-9.9 months. Recurrence of lupus was not reported in any patient, including six cases where it was specifically indicated that there was no recurrence. Conclusion: Based on reported cases, heart transplantation in SLE is a viable option, with good survival and no recurrence of lupus in the transplanted heart. In cases of intractable heart failure in patients with SLE, cardiac transplantation should be considered.
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