Author + information
- Received October 9, 2019
- Revision received December 16, 2019
- Accepted December 17, 2019
- Published online May 25, 2020.
- Christopher D. Barrett, MDa,
- Kevin M. Alexander, MDb,
- Hongyu Zhao, MDc,
- Francois Haddad, MDb,
- Paul Cheng, MD, PhDb,
- Ronglih Liao, PhDb,
- Matthew T. Wheeler, MDb,
- Michaela Liedtke, MDb,
- Stanley Schrier, MDb,∗,
- Sally Arai, MDb,
- Dana Weisshaar, MDc and
- Ronald M. Witteles, MDb,∗ ()
- aDivision of Cardiology, University of Colorado Denver, Denver, Colorado
- bStanford Amyloid Center, Stanford University School of Medicine, Stanford, California
- cKaiser Permanente Northern California, Santa Clara, California
- ↵∗Address for correspondence:
Dr. Ronald M. Witteles, Stanford University School of Medicine, 300 Pasteur Dr., Lane Building #L158, Stanford, California 94305.
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.
↵∗ Dr. Schrier is deceased.
Dr. Alexander has been a member of the Advisory Board for Alnylam; and has received a research grant from Pfizer. Dr. Liedtke has received fees from Prothena, Amgen, Caelum, Takeda, Gilead, Adaptive, Jazz, Janssen, Celgene, and Pfizer. Dr. Witteles has been a member of the Advisory Board for Pfizer, Alynylam, and Eidos. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received October 9, 2019.
- Revision received December 16, 2019.
- Accepted December 17, 2019.
- 2020 American College of Cardiology Foundation
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