OBJECTIVES: The purpose of this study is to report outcomes after heart transplantation in patients with cardiac amyloidosis based on a large single-center experience. BACKGROUND: Cardiac amyloidosis causes significant morbidity and mortality, often leading to restrictive cardiomyopathy, progressive heart failure, and death. Historically, heart transplantation outcomes have been worse in patients with cardiac amyloidosis compared with other heart failure populations, in part due to the systemic nature of the disease. However, several case series have suggested that transplantation outcomes may be better in the contemporary era, likely in part due to the availability of more effective light chain suppressive therapies for light chain amyloidosis. METHODS: This study examined all patients seen between 2004 and 2017, either at the Stanford University Medical Center or the Kaiser Permanente Santa Clara Medical Center, who were diagnosed with cardiac amyloidosis and ultimately underwent heart transplantation. This study examined pre-transplantation characteristics and post-transplantation outcomes in this group compared with the overall transplantation population at our center. RESULTS: During the study period, 31 patients (13 with light chain amyloidosis and 18 with transthyretin [ATTR] amyloidosis) underwent heart transplantation. Patients with ATTR amyloidosis were older, were more likely to be male, had worse baseline renal function, and had longer waitlist times compared with both patients with light chain amyloidosis and the overall transplantation population. Post-transplantation, there were no differences in post-operative bleeding, renal failure, infection, rejection, or malignancy. There was no significant difference in mortality between patients who underwent heart transplantation for amyloid cardiomyopathy and patients who underwent heart transplantation for all other indications. CONCLUSIONS: In carefully selected patients with cardiac amyloidosis, heart transplantation can be an effective therapeutic option with outcomes similar to those transplanted for other causes of heart failure.
OBJECTIVES: The purpose of this study is to report outcomes after heart transplantation in patients with cardiac amyloidosis based on a large single-center experience. BACKGROUND:Cardiac amyloidosis causes significant morbidity and mortality, often leading to restrictive cardiomyopathy, progressive heart failure, and death. Historically, heart transplantation outcomes have been worse in patients with cardiac amyloidosis compared with other heart failure populations, in part due to the systemic nature of the disease. However, several case series have suggested that transplantation outcomes may be better in the contemporary era, likely in part due to the availability of more effective light chain suppressive therapies for light chain amyloidosis. METHODS: This study examined all patients seen between 2004 and 2017, either at the Stanford University Medical Center or the Kaiser Permanente Santa Clara Medical Center, who were diagnosed with cardiac amyloidosis and ultimately underwent heart transplantation. This study examined pre-transplantation characteristics and post-transplantation outcomes in this group compared with the overall transplantation population at our center. RESULTS: During the study period, 31 patients (13 with light chain amyloidosis and 18 with transthyretin [ATTR] amyloidosis) underwent heart transplantation. Patients with ATTRamyloidosis were older, were more likely to be male, had worse baseline renal function, and had longer waitlist times compared with both patients with light chain amyloidosis and the overall transplantation population. Post-transplantation, there were no differences in post-operative bleeding, renal failure, infection, rejection, or malignancy. There was no significant difference in mortality between patients who underwent heart transplantation for amyloid cardiomyopathy and patients who underwent heart transplantation for all other indications. CONCLUSIONS: In carefully selected patients with cardiac amyloidosis, heart transplantation can be an effective therapeutic option with outcomes similar to those transplanted for other causes of heart failure.
Authors: Jan M Griffin; Ersilia M DeFilippis; Hannah Rosenblum; Veli K Topkara; Justin A Fried; Nir Uriel; Koji Takeda; Maryjane A Farr; Mathew S Maurer; Kevin J Clerkin Journal: Clin Transplant Date: 2020-10-28 Impact factor: 2.863
Authors: Pranav Chandrashekar; Laith Alhuneafat; Meghan Mannello; Lana Al-Rashdan; Morris M Kim; Jason Dungu; Kevin Alexander; Ahmad Masri Journal: Circ Genom Precis Med Date: 2021-08-31
Authors: Jan M Griffin; Leonard Chiu; Kelly M Axsom; Rachel Bijou; Kevin J Clerkin; Paolo Colombo; Margaret O Cuomo; Jeffeny De Los Santos; Justin A Fried; Jeff Goldsmith; Marlena Habal; Jennifer Haythe; Stephen Helmke; Evelyn M Horn; Farhana Latif; Sun Hi Lee; Edward F Lin; Yoshifumi Naka; Jayant Raikhelkar; Susan Restaino; Gabriel T Sayer; Hiroo Takayama; Koji Takeda; Sergio Teruya; Veli Topkara; Emily J Tsai; Nir Uriel; Melana Yuzefpolskaya; Maryjane A Farr; Mathew S Maurer Journal: Clin Transplant Date: 2020-07-24 Impact factor: 2.863
Authors: Barry J Maron; Martin S Maron; Mathew S Maurer; Ethan J Rowin; Bradley A Maron; Nazzareno Galiè Journal: J Am Heart Assoc Date: 2021-10-08 Impact factor: 5.501