Heart transplant feasible option for end-stage cardiac amyloidosis
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Heart transplant is a viable treatment option for adults at an advanced stage of cardiac amyloidosis, as overall survival after transplantation has continued to improve over 3 decades, data from a retrospective study show.
“Heart transplantation is a feasible treatment option for end-stage cardiac amyloidosis, and outcomes in this patient group are not inferior to other heart transplantation patients,” Martin J. Kraus, MD, of the division of cardiology at the University of Heidelberg, Germany, told Healio. “Survival following heart transplant has drastically improved since 2008 for amyloidosis patients due to new treatment options, such as proteasome inhibitors, and improved patient selection. Amyloidosis patients in a worse general condition, represented by a lower BP and lower albumin concentration, seem to have a worse outcome. Established risk scores like the Mayo staging system do not predict outcomes after heart transplant in these patients.”
Kraus and colleagues analyzed data from 115 patients who underwent heart transplant due to cardiac amyloidosis, using data from the Eurotransplant registry between November 1987 and May 2020. A detailed assessment before transplantation was available for 85 patients. The primary endpoint was mortality after heart transplant.
The findings were published in the Journal of Heart and Lung Transplantation.
The median overall survival after heart transplant was 6.3 years both for the overall cohort and for the subgroup of patients with more detailed information. Researchers observed a relationship between overall survival and the transplantation period. The median survival was 9.7 years for those who underwent heart transplant between 2008 and 2020, whereas median survival was 1.8 years for those who underwent transplant between 1987 and 2007 (HR = 0.45; P = .01).
Among patients with more detailed information, other predictors of mortality were lower vs. higher albumin concentration at baseline (HR = 0.92; 95% CI, 0.88-0.97; P < .001), and lower vs. higher systolic BP at baseline (HR = 0.96; 95% CI, 0.93-0.99; P < .001).
“Cardiac amyloidosis patients should be referred early to a specialized center,” Kraus told Healio. “When the disease comes to an advanced stage, a heart transplantation should always be considered as an important treatment option. Patient selection and a modern hematologic treatment are crucial for amyloidosis patients to improve outcomes after heart transplant.”
To improve patient selection for heart transplant, Kraus said larger studies are needed to find more predictors of outcomes, especially for patients with amyloid transthyretin cardiomyopathy (ATTM).
“This is crucial to improve outcomes after heart transplant in a situation where the number of donors is limited,” Kraus said.
For more information:
Martin J. Kraus, MD, can be reached at martin.kraus@med.uni-heidelberg.de; Twitter: @espressobohne91.
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