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
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Bibliography
Merlini, G, Bellotti, V, Molecular mechanisms of amyloidosis. N Engl J Med 349 (2003), 583–596.
Bellotti, V, Nuvolone, M, Giorgetti, S, et al. The workings of the amyloid diseases. Ann Med 39 (2007), 200–207.
Gertz, MA, Dispenzieri, A, Sher, T, Pathophysiology and treatment of cardiac amyloidosis. Nat Rev Cardiol 12 (2015), 91–102.
Siddiqi, OK, Ruberg, FL, Cardiac amyloidosis: an update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc Med 28 (2018), 10–21.
Rubin, J, Maurer, MS, Cardiac amyloidosis: overlooked, underappreciated, and treatable. Annu Rev Med 71 (2020), 203–219.
Gertz, MA, Immunoglobulin light chain amyloidosis: 2018 Update on diagnosis, prognosis, and treatment. Am J Hematol 93 (2018), 1169–1180.
Maurer, MS, Schwartz, JH, Gundapaneni, B, et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med 379 (2018), 1007–1016.
Adams, D, Gonzalez-Duarte, A, O'Riordan, WD, et al. Patisiran, an RNAi therapeutic, for hereditary transthyretin amyloidosis. N Engl J Med 379 (2018), 11–21.
Selvanayagam, JB, Hawkins, PN, Paul, B, Myerson, SG, Neubauer, S, Evaluation and management of the cardiac amyloidosis. J Am Coll Cardiol 50 (2007), 2101–2110.
Volz, MJ, Pleger, ST, Weber, A, et al. Initial experience with percutaneous mitral valve repair in patients with cardiac amyloidosis. Eur J Clin Invest, 51, 2021, e13473, 10.1111/eci.13473.
Swiecicki, PL, Edwards, BS, Kushwaha, SS, Dispenzieri, A, Park, SJ, Gertz, MA, Left ventricular device implantation for advanced cardiac amyloidosis. J Heart Lung Transplant 32 (2013), 563–568.
Lin, G, Dispenzieri, A, Kyle, R, Grogan, M, Brady, PA, Implantable cardioverter defibrillators in patients with cardiac amyloidosis. J Cardiovasc Electrophysiol 24 (2013), 793–798.
Sousa, M, Monohan, G, Rajagopalan, N, Grigorian, A, Guglin, M, Heart transplantation in cardiac amyloidosis. Heart Fail Rev 22 (2017), 317–327.
Kristen, Av., Kreusser, MM, Blum, P, et al. Improved outcomes after heart transplantation for cardiac amyloidosis in the modern era. J Heart Lung Transplant 37 (2018), 611–618.
Davis, MK, Lee, PHU, Witteles, RM, Changing outcomes after heart transplantation in patients with amyloid cardiomyopathy. J Heart Lung Transplant 34 (2015), 658–666.
Gray Gilstrap, L, Niehaus, E, Malhotra, R, et al. Predictors of survival to orthotopic heart transplant in patients with light chain amyloidosis. J Heart Lung Transplant 33 (2014), 149–156.
Vaidya, GN, Patel, JK, Kittleson, M, et al. Intermediate-term outcomes of heart transplantation for cardiac amyloidosis in the current era. Clin Transplant, 35, 2021, e14308, 10.1111/ctr.14308.
CD Barrett, KM Alexander, H Zhao, et al., Outcomes in patients with cardiac amyloidosis undergoing heart transplantation, JACC Heart Fail, 8, 461–468, 2020.
Chen, Q, Moriguchi, J, Levine, R, et al. Outcomes of heart transplantation in cardiac amyloidosis patients: a single center experience. Transplant Proc 53 (2021), 329–334.
Mehra, MR, Canter, CE, Hannan, MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant 35 (2016), 1–23.
Declaration of Helsinki World Medical Association declaration of Helsinki. Bull World Health Organ, 79, 2013 JAVA.
ISHLT Board. International Society for Heart and Lung Transplantation Statement on Transplant Ethics. 2014.
Kittleson, MM, Maurer, MS, Ambardekar, A v., et al. Cardiac amyloidosis: evolving diagnosis and management: a scientific statement from the American Heart Association. Circulation 142 (2020), e7–e22.
Kreusser, MM, Volz, MJ, Knop, B, et al. A novel risk score to predict survival in advanced heart failure due to cardiac amyloidosis. Clin Res Cardiol 109 (2020), 700–713.
Dispenzieri, A, Gertz, MA, Kyle, RA, et al. Serum cardiac troponins and N-terminal pro-brain natriuretic peptide: a staging system for primary systemic amyloidosis. J Clin Oncol 22 (2004), 3751–3757.
Grogan, M, Scott, CG, Kyle, RA, et al. Natural history of wild-type transthyretin cardiac amyloidosis and risk stratification using a novel staging system. J Am Coll Cardiol 68 (2016), 1014–1020.
Gillmore, JD, Damy, T, Fontana, M, et al. A new staging system for cardiac transthyretin amyloidosis. Eur Heart J 39 (2018), 2799–2806.
Gertz, MA, Comenzo, R, Falk, RH, et al. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis. Am J Hematol, 2005, 79, 319-328.
ISHLT. Focus theme: trends in recipient characteristics and impact on outcomes. 2021.
The International Society of Heart and Lung Transplantation. ISHLT transplant registry quarterly reports for heart in Europe. 2018.
Kimmich, CR, Terzer, T, Benner, A, et al. Daratumumab for systemic AL amyloidosis: prognostic factors and adverse outcome with nephrotic-range albuminuria. Blood 135 (2020), 1517–1530.
Wechalekar, AD, Schonland, SO, Kastritis, E, et al. A European collaborative study of treatment outcomes in 346 patients with cardiac stage III AL amyloidosis. Blood 121 (2013), 3420–3427.
Zhang, Z, Pereira, SL, Luo, M, Matheson, EM, Evaluation of blood biomarkers associated with risk of malnutrition in older adults: a systematic review and meta-analysis. Nutrients, 9, 2017, 829.
Franco, OH, Peeters, A, Bonneux, L, de Laet, C, Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women: life course analysis. Hypertension 46 (2005), 280–286.
Similar publications
Sorry the service is unavailable at the moment. Please try again later.
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.
