United network for organ sharing outcomes after heart transplantation for al compared to ATTR cardiac amyloidosis.

Abstract

Light-chain (AL) cardiac amyloidosis (CA) has a worse prognosis than transthyretin (ATTR) CA. In this single-center study, we compared post-heart transplant (OHT, orthotopic heart transplantation) survival for AL and ATTR amyloidosis, hypothesizing that these differences would persist post-OHT. Thirty-nine patients with CA (AL, n = 18; ATTR, n = 21) and 1023 non-amyloidosis subjects undergoing OHT were included. Cox proportional hazards modeling was used to evaluate the impact of amyloid subtype and era (early era: from 2001 to 2007; late era: from 2008 to 2018) on survival post-OHT. Survival for non-amyloid patients was greater than ATTR (P = .034) and AL (P < .001) patients in the early era. One, 3-, and 5-year survival rates were higher for ATTR patients than AL patients in the early era (100% vs 75%, 67% vs 50%, and 67% vs 33%, respectively, for ATTR and AL patients). Survival in the non-amyloid cohort was 87% at 1 year, 81% at 3 years, and 76% at 5 years post-OHT. In the late era, AL and ATTR patients had unadjusted 1-year, 3-year, and 5-year survival rates of 100%, which was comparable to non-amyloid patients (90% vs 84% vs 81%). Overall, these findings demonstrate that in the current era, differences in post-OHT survival for AL compared to ATTR are diminishing; OHT outcomes for selected patients with CA do not differ from non-amyloidosis patients.

• 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: Clinical transplantation (Clin Transplant) Vol. 34 Issue 10 Pg. e14028 (10 2020) ISSN: 1399-0012 [Electronic] Denmark
• PMID: 32623785 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Prealbumin

Topics

• Amyloid Neuropathies, Familial (surgery)
• Amyloidosis
• Cardiomyopathies (etiology)
• Heart Transplantation
• Humans
• Prealbumin
• Prognosis
• Survival Rate