Date of Presentation

5-2-2019 12:00 AM

College

School of Osteopathic Medicine

Poster Abstract

Background: Both amyloid light chain (AL) amyloidosis and transthyretin-related (TTR) amyloid are expanding indications for heart transplantation (HTx). In the past, AL amyloid, in particular, had been a contraindication to HTx given its systemic nature and the increased risk for mortality. Modern treatments including proteasome inhibitors have allowed amyloid patients to receive heart transplants at an increasing rate. We sought to assess long-term post-transplant outcome in amyloid patients in the current era.

Methods: Between 2010 and 2015, we assessed 27 patients (5 AL, 10 TTR-wildtype (wt), 12 TTR-mutant (m)) underwent heart transplant for cardiac amyloidosis at our single center. A non-amyloid restrictive cardiomyopathy control population was included (n=18). Endpoints included 3-year outcomes including survival, freedom from CAV (as #212121">defined by stenosis ≥ 30% by angiography), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and freedom from any-treated rejection, acute cellular rejection, and antibody-mediated rejection.

Results: There was no significant difference between the AL amyloid, TTR-wt, TTR-m, and restrictive non-amyloid patients with respect to 3-year survival and 3-year freedom from CAV, NF-MACE, and rejection (see table). Endomyocardial biopsies post-transplant did not show amyloid. (see Table)

Conclusion: In the current era, both AL and TTR amyloid patients have acceptable mid-term outcome after heart transplantation. Larger numbers and longer follow up are needed to confirm these findings.

Keywords

heart transplant, amyloid, amyloidosis, post-transplant outcome

Disciplines

Hemic and Lymphatic Diseases | Medicine and Health Sciences

Document Type

Poster

Share

COinS
 
May 2nd, 12:00 AM

The Evolving Long-Term Outcome of Heart Transplantation in Amyloid Patients

Background: Both amyloid light chain (AL) amyloidosis and transthyretin-related (TTR) amyloid are expanding indications for heart transplantation (HTx). In the past, AL amyloid, in particular, had been a contraindication to HTx given its systemic nature and the increased risk for mortality. Modern treatments including proteasome inhibitors have allowed amyloid patients to receive heart transplants at an increasing rate. We sought to assess long-term post-transplant outcome in amyloid patients in the current era.

Methods: Between 2010 and 2015, we assessed 27 patients (5 AL, 10 TTR-wildtype (wt), 12 TTR-mutant (m)) underwent heart transplant for cardiac amyloidosis at our single center. A non-amyloid restrictive cardiomyopathy control population was included (n=18). Endpoints included 3-year outcomes including survival, freedom from CAV (as #212121">defined by stenosis ≥ 30% by angiography), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and freedom from any-treated rejection, acute cellular rejection, and antibody-mediated rejection.

Results: There was no significant difference between the AL amyloid, TTR-wt, TTR-m, and restrictive non-amyloid patients with respect to 3-year survival and 3-year freedom from CAV, NF-MACE, and rejection (see table). Endomyocardial biopsies post-transplant did not show amyloid. (see Table)

Conclusion: In the current era, both AL and TTR amyloid patients have acceptable mid-term outcome after heart transplantation. Larger numbers and longer follow up are needed to confirm these findings.

 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.