Heart Transplant Outcomes in Chemotherapy-Induced vs. Non-Ischemic-Dilated Cardiomyopathy: Pediatric and Adult Recipients in the Ventricular Assist Device Era

Background: Chemotherapy-induced dilated cardiomyopathy (CIDCM) has become an increasingly recognized indication for heart transplantation (HT) among cancer survivors with end-stage heart failure (HF). Advances in cardio-oncology practices, mechanical circulatory support, and refined immunosuppression strategies have improved outcomes; however, comparative data with non-ischemic dilated cardiomyopathy (NIDCM) in the modern ventricular assist device (VAD) era remain limited. Therefore, this study primarily aimed to compare post-transplant outcomes between CIDCM and NIDCM within pediatric and adult cohorts in the VAD era. Methods: Data from the United Network for Organ Sharing (UNOS) registry were used to retrospectively analyze first-time orthotopic HT recipients between January 2010 and March 2023, with follow-up through March 2024. CIDCM was defined using the UNOS diagnosis codes "dilated myopathy-adriamycin" or "dilated myopathy-cancer", whereas NIDCM included idiopathic, familial, myocarditis-related, and other specific DCM subtypes. Primary outcomes were post-HT survival, treated allograft rejection, and new or recurrent malignancy. Results: = 0.0027), with similar incidence of post-HT malignancy. Older age, female sex, and minority race were associated with reduced survival. In pediatric recipients, age >10 years and Ebstein Bar Virus (EBV) seronegativity were associated with post-HT malignancy; in adults, age ≥50 years was predictive. Conclusions: HT in CIDCM achieves durable survival and safety comparable to NIDCM. These results support expanding HT eligibility and multidisciplinary evaluation for cancer survivors with advanced HF in the contemporary era.