Vincent Algalarrondo1, Teresa Antonini2, Marie Théaudin3, Denis Chemla4, Anouar Benmalek5, Denis Castaing2, Cécile Cauquil3, François Rouzet6, Delphine Mika7, Eric Duong8, Sylvie Dinanian9, Ludivine Eliahou1, Dominique Le Guludec6, Didier Samuel2, David Adams3, Michel S Slama10. 1. a Cardiology department , Bichat Claude Bernard Hospital, AP-HP, Université Paris Diderot , Paris , France. 2. b Hepato-Biliary Center, Paul Brousse hospital, AP-HP, UMR-S 785, Univ. Paris-Sud , Villejuif , France. 3. c FILNEMUS, Neurology Department , Kremlin Bicêtre hospital, AP-HP, Univ. Paris-Sud , Bicêtre , France. 4. d Physiology Department , EA4533, Univ. Paris-Sud , Le Kremlin Bicêtre , France. 5. e School of Pharmacy, University of Paris-Sud , Chatenay Malabry , France. 6. f Nuclear medicine Department and DHU FIRE , Bichat Claude Bernard hospital, AP-HP, Université Paris Diderot, U1148 , Paris , France. 7. g INSERM UMR-S 1180, University of Paris-Sud , Chatenay-Malabry , France. 8. h Faculty of Pharmacy and Pharmaceutical Sciences , University of Alberta , Edmonton , Alberta , Canada. 9. i Cardiology department , Antoine Béclère Hospital, AP-HP , Clamart , France. 10. j Cardiology department , Bichat Claude Bernard Hospital, AP-HP, University of Paris-Sud , Paris , France.
Abstract
BACKGROUND: Hereditary transthyretin amyloidosis (ATTR) is a multisystemic disease involving mainly the peripheral nervous system and the heart. Liver transplantation (LT) is the reference treatment for ATTR neuropathy and preoperative detection of high risk patients is crucial. We aimed to document the causes of death of ATTR patients after LT, their temporal trends, and to evaluate whether the available preoperative tools that predict the risk of death after LT for hereditary ATTR amyloidosis matched with these trends. METHODS: A retrospective longitudinal cohort study was performed on 215 consecutive ATTR patients who underwent LT between January 1993 and January 2011. Each patient's death cause and timing were classified. RESULTS: Over a median follow up of 5.9 years, 84 patients died. The rate of death was higher in the first year following LT than thereafter (13.0 vs. 4.3 ± 1.8%/year; p = .004). Cardiac events ranked as the leading cause of death (C: 38%), followed by infections (I: 24%), graft complications (G: 17%), end stage amyloidosis, stroke and others (ASO: 7% each). Deaths due to graft complications and infections (GI) occurred earlier than those due to end stage amyloidosis and stroke. Death prediction was less accurate for GI-related mortality than for other causes, which blunted the accuracy of the early-term risk prediction scores. Conclusions In ATTR amyloidosis, cardiac events were the leading cause of death after liver transplantation. Close preoperative evaluation allowed for accurate mid-term prediction of mortality, but the high rate of graft complications and infections blunted the early-term risk prediction.
BACKGROUND:Hereditary transthyretin amyloidosis (ATTR) is a multisystemic disease involving mainly the peripheral nervous system and the heart. Liver transplantation (LT) is the reference treatment for ATTRneuropathy and preoperative detection of high risk patients is crucial. We aimed to document the causes of death of ATTRpatients after LT, their temporal trends, and to evaluate whether the available preoperative tools that predict the risk of death after LT for hereditary ATTRamyloidosis matched with these trends. METHODS: A retrospective longitudinal cohort study was performed on 215 consecutive ATTRpatients who underwent LT between January 1993 and January 2011. Each patient's death cause and timing were classified. RESULTS: Over a median follow up of 5.9 years, 84 patientsdied. The rate of death was higher in the first year following LT than thereafter (13.0 vs. 4.3 ± 1.8%/year; p = .004). Cardiac events ranked as the leading cause of death (C: 38%), followed by infections (I: 24%), graft complications (G: 17%), end stage amyloidosis, stroke and others (ASO: 7% each). Deaths due to graft complications and infections (GI) occurred earlier than those due to end stage amyloidosis and stroke. Death prediction was less accurate for GI-related mortality than for other causes, which blunted the accuracy of the early-term risk prediction scores. Conclusions In ATTRamyloidosis, cardiac events were the leading cause of death after liver transplantation. Close preoperative evaluation allowed for accurate mid-term prediction of mortality, but the high rate of graft complications and infections blunted the early-term risk prediction.
Authors: Hartmut H Schmidt; Jonas Wixner; Violaine Planté-Bordeneuve; Francisco Muñoz-Beamud; Laura Lladó; Julian D Gillmore; Anna Mazzeo; Xingyu Li; Seth Arum; Patrick Y Jay; David Adams Journal: Am J Transplant Date: 2022-03-26 Impact factor: 9.369
Authors: Anca Florian; Michael Bietenbeck; Grigorios Chatzantonis; Anna Hüsing-Kabar; Hartmut Schmidt; Ali Yilmaz Journal: Clin Res Cardiol Date: 2020-02-11 Impact factor: 5.460