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Improved outcomes after heart transplantation for cardiac amyloidosis in the modern era

Background: Cardiac amyloidosis, caused most commonly by deposition of light chain (AL) or transthyretin (ATTR) type fibrils, has an extremely poor prognosis. In this retrospective single-center study, we evaluated temporal trends in survival after heart transplantation for cardiac amyloidosis. Meth...

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Main Authors: Kristen, Arnt (Author) , Kreußer, Michael (Author) , Blum, Patrick (Author) , Schönland, Stefan (Author) , Frankenstein, Lutz (Author) , Dösch, Andreas (Author) , Knop, Benjamin (Author) , Helmschrott, Matthias (Author) , Schmack, Bastian (Author) , Ruhparwar, Arjang (Author) , Hegenbart, Ute (Author) , Katus, Hugo (Author) , Raake, Philip (Author)
Format: Article (Journal)
Language:English
Published: 2018
In: The journal of heart and lung transplantation
Year: 2018, Volume: 37, Issue: 5, Pages: 611-618
ISSN:1557-3117
DOI:10.1016/j.healun.2017.11.015
Online Access:Verlag, Volltext: http://dx.doi.org/10.1016/j.healun.2017.11.015
Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S1053249817321162
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Author Notes:Arnt V. Kristen, Michael M. Kreusser, Patrick Blum, Stefan O. Schönland, Lutz Frankenstein, Andreas O. Dösch, Benjamin Knop, Matthias Helmschrott, Bastian Schmack, Arjang Ruhparwar, Ute Hegenbart, Hugo A. Katus, and Philip W.J. Raake
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Summary:Background: Cardiac amyloidosis, caused most commonly by deposition of light chain (AL) or transthyretin (ATTR) type fibrils, has an extremely poor prognosis. In this retrospective single-center study, we evaluated temporal trends in survival after heart transplantation for cardiac amyloidosis. Methods: We analyzed 48 patients with cardiac amyloidosis (AL, n = 32; familial ATTR, n = 16) who underwent heart transplantation from May 2002 to March 2017. Patients were analysed in 2 periods, Era 1 (2002- 2007) and Era 2 (2008- 2017), separated by altered patient selection in both, AL and ATTR amyloidosis, and changed chemotherapy regimens for AL amyloidosis. Results: The modern era was characterized by a lower number of extracardiac organ involvement for AL (94% isolated cardiac amyloidosis in Era 2 vs 56% in Era 1; p = 0.0221), and more frequent treatment for AL with the proteasome inhibitor bortezomib (94% in Era 2 vs 6% in Era 1; p < 0.0001). AL patients had significantly lower survival than patients with non-amyloid cardiomyopathy after heart transplantation in Era 1, and ATTR patients had numerically lower survival. However, survival in the modern era was comparable to non-amyloid transplants in both cohorts, possibly reflecting a shift in chemotherapy strategies and patient selection, respectively. Conclusions: In the current era, use of enhanced chemotherapy regimens for isolated advanced AL cardiac amyloidosis was associated with outcomes comparable to non-amyloid cardiomyopathy. We conclude that heart transplantation in highly selected patients with isolated non-systemic advanced cardiac amyloidosis may be a feasible approach.
Item Description:First published: 15 November 2017
Gesehen am 26.06.2018
Physical Description:Online Resource
ISSN:1557-3117
DOI:10.1016/j.healun.2017.11.015

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