Amyloidosis/complications; Heart Transplantation; Cardiology and Cardiovascular Medicine
Abstract :
[en] [en] BACKGROUND: When advanced heart failure occurs in cardiac amyloidosis, prognosis is poor. In this setting heart transplantation (HTX) is a treatment option for selected patients. We here present the results of post-transplantation outcomes in cardiac amyloidosis within the Eurotransplant area, investigating possible predictors of survival.
METHODS: Of 115 patients undergoing HTX due to cardiac amyloidosis in the Eurotransplant region between November 1987 and May 2020, detailed assessment prior to transplantation was available in 85 patients. The present study was conducted in a retrospective approach. Primary endpoint was mortality after HTX. Baseline variables were entered in a Cox proportional hazards model with the primary endpoint as a dependent variable.
RESULTS: Median overall survival following HTX was 6.3 years in the overall collective and the subgroup. Univariate Cox proportional hazards model revealed a significant relationship between overall survival and the transplantation period (2008 to 2020 vs 1987 to 2007; median survival 9.7 years vs 1.8 years, hazard ratio 0.45, p = 0.01). Further predictors were albumin concentration (hazard ratio 0.92, p < 0.001), and systolic blood pressure (hazard ratio 0.96, p < 0.001). The transplant period as well as albumin concentration remained significant independent predictors in the AL sub cohort in a multivariate Cox proportional hazards model.
CONCLUSIONS: HTX is a viable treatment option for patients at an advanced stage of cardiac amyloidosis as overall survival after transplantation has improved in the modern age. Patients at a very advanced stage of the disease, indicated by low serum albumin and blood pressure, show worse outcomes following HTX. Optimal timing and careful patient selection may therefore be particularly important to further improve post-HTX survival in amyloidosis patients.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Kraus, Martin J ; Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany. Electronic address: martin.kraus@med.uni-heidelberg.de
Smits, Jacqueline M; Eurotransplant, Leiden, Netherlands
Meyer, Anna L; Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
van Kins, Arne; Eurotransplant, Leiden, Netherlands
Boeken, Udo ; Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
Reinecke, Alexander; Department of Cardiology, Angiology and Intensive Care, University of Kiel, Kiel, Germany
Provaznik, Zdenek; Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
Van Caenegem, Oliver; Cardiovascular Department, Intensive Care Unit, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (deceased
Ancion, Arnaud ; Université de Liège - ULiège > Département des sciences cliniques
Berchtold-Herz, Michael; Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany, Department of Medicine, University Heart Center Freiburg, Freiburg, Germany
Van Cleemput, Johan J A; Department of Cardiology, University Hospital Leuven, Leuven, Belgium
Haverich, Axel; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
Laufer, Guenther; Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
Gummert, Jan; Heart and Diabetes Center Nord-Rhein-Westfalen, Ruhr University Bochum, Bochum, Germany
Karck, Matthias; Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Warnecke, Gregor ; Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Raake, Philip W; Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany, DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany, Department of Cardiology, University Hospital of Augsburg, Augsburg Germany
Frey, Norbert; Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany, DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
Kreusser, Michael M; Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany, DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
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