心脏移植后心脏结节病(CS)和巨细胞心肌炎(GCM)的复发很少见,CS率为5%,GCM率为8%。我们旨在确定文献中所有报告的复发病例,并评估临床过程。治疗,和结果,以提高对条件的理解。系统的审查,利用系统评价和荟萃分析(PRISMA)指南的首选报告项目,通过搜索MEDLINE/PubMed和Embase所有描述移植后复发性肉芽肿性心肌炎的现有文献进行,CS,或GCM。人口统计数据,移植,复发,管理,并从每个出版物中收集结果数据.采用标准统计学方法对两组进行比较。在33篇出版物中,有39例患者发现了移植后GM复发。报告病例包括24例GCM,12CS,3起疑似病例。病例报告是最常见的出版形式。GCM复发患者的平均年龄为42岁,CS和偏爱男性患者为48岁(62%)。移植后复发时间为2周至9年,发生在GCM早期(平均1.8年vs3.0年)。与心脏磁共振和正电子发射断层扫描相比,心内膜活检(89%)是最常用的诊断方法。复发治疗方案仅涉及40%CS的类固醇,而其他免疫调节方案在70%的GCM中使用。总之,心脏移植后GCM和CS复发具有相关风险,包括并发急性细胞排斥反应,与CS相比,对GCM复发的治疗需求更高,和死亡率。新的无创筛查技术可能有助于修改移植后监测方案,以增加复发的早期发现和治疗。
Recurrence of cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) after heart transplant is rare, with rates of 5% in CS and 8% in GCM. We aim to identify all reported cases of recurrence in the literature and to assess clinical course, treatments, and outcomes to improve understanding of the conditions. A systematic
review, utilizing Preferred Reporting Items for Systematic
Review and Meta-Analyses (PRISMA) guidelines, was conducted by searching MEDLINE/PubMed and Embase of all available literature describing post-transplant recurrent granulomatous myocarditis, CS, or GCM. Data on demographics, transplant, recurrence, management, and outcomes data were collected from each publication. Comparison between the 2 groups were made using standard statistical approaches. Post-transplant GM recurrence was identified in 39 patients in 33 total publications. Reported cases included 24 GCM, 12 CS, and 3 suspected cases. Case reports were the most frequent form of publication. Mean age of patients experiencing recurrence was 42 years for GCM and 48 years for CS and favored males (62%). Time to recurrence ranged from 2 weeks to 9 years post-transplant, occurring earlier in GCM (mean 1.8 vs 3.0 years). Endomyocardial biopsies (89%) were the most utilized diagnostic method over cardiac magnetic resonance and positron emission tomography. Recurrence treatment regimens involved only steroids in 40% of CS, whereas other immunomodulatory regimens were utilized in 70% of GCM. In conclusion, GCM and CS recurrence after cardiac transplantation holds associated risks including concurrent acute cellular rejection, a higher therapeutic demand for GCM recurrence compared with CS, and mortality. New noninvasive screening techniques may help modify post-transplant monitoring regimens to increase both early detection and treatment of recurrence.