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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Outcomes in patients with cardiac amyloidosis undergoing heart transplantation: the eurotransplant experience

Published:January 11, 2023DOI:https://doi.org/10.1016/j.healun.2023.01.001

      Background

      When advanced heart failure occurs in cardiac amyloidosis, prognosis is poor. In this setting heart transplantation (HTX) is a treatment option for selected patients. We here present the results of post-transplantation outcomes in cardiac amyloidosis within the Eurotransplant area, investigating possible predictors of survival.

      Methods

      Of 115 patients undergoing HTX due to cardiac amyloidosis in the Eurotransplant region between November 1987 and May 2020, detailed assessment prior to transplantation was available in 85 patients. The present study was conducted in a retrospective approach. Primary endpoint was mortality after HTX. Baseline variables were entered in a Cox proportional hazards model with the primary endpoint as a dependent variable.

      Results

      Median overall survival following HTX was 6.3 years in the overall collective and the subgroup. Univariate Cox proportional hazards model revealed a significant relationship between overall survival and the transplantation period (2008 to 2020 vs 1987 to 2007; median survival 9.7 years vs 1.8 years, hazard ratio 0.45, p = 0.01). Further predictors were albumin concentration (hazard ratio 0.92, p < 0.001), and systolic blood pressure (hazard ratio 0.96, p < 0.001). The transplant period as well as albumin concentration remained significant independent predictors in the AL sub cohort in a multivariate Cox proportional hazards model.

      Conclusions

      HTX is a viable treatment option for patients at an advanced stage of cardiac amyloidosis as overall survival after transplantation has improved in the modern age. Patients at a very advanced stage of the disease, indicated by low serum albumin and blood pressure, show worse outcomes following HTX. Optimal timing and careful patient selection may therefore be particularly important to further improve post-HTX survival in amyloidosis patients.

      Abbreviations:

      AL (Immunoglobulin lightchain), ATTR (Transthyretin), HTX (Heart transplantation), HU (High urgency), ISHLT (The International Society for Heart and Lung Transplantation), NYHA (New York Heart Association), ASCT (Autologous stem cell transplantation), NTproBNP (N-terminal prohormone of brain natriuretic peptide), hsTnT (High-sensitivity troponin T), SvO2 (Mixed venous oxygen saturation), PCWP (Pulmonary capillary wedge pressure), PAP (Pulmonary artery pressure), CI (Cardiac index), CVP (Central venous pressure), PVR (Pulmonary vascular resistance), LVEF (Left ventricular ejection fraction), LVEDD (Left ventricular enddiastolic diameter), LVESD (Left ventricular endsystolic diameter)
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