Researchers from the Cedars-Sinai Medical Center found that cardiac transplantation can be safely performed in select patients with amyloidosis with reasonable short-term clinical outcomes.
Previously, light-chain (AL) amyloidosis was considered a contraindication to heart transplantation given a higher risk of biventricular failure requiring mechanical circulatory support (MCS). In this study, the investigators assessed outcomes of patients with end-stage cardiac amyloidosis (CA) who underwent cardiac transplantation, including patients who were bridged to transplantation with a durable biventricular MCS.
The investigators reviewed records for patients with CA who underwent cardiac transplant between 2010 and 2018. A total of 46 patients with either AL or transthyretin (ATTR) amyloidosis received heart transplantation, seven of whom were bridged with a durable biventricular MCS device (six with AL and one with ATTR). The MCS group consisted of five artificial hearts and two biventricular assist devices.
The primary endpoint was post-transplant survival at one year. Secondary endpoints included one-year freedom from cardiac allograft vasculopathy, defined as stenosis ≥30% by angiography, non-fatal major adverse cardiac events, and any rejection.
At one year, survival was 91% for the entire cohort, 83% for those with AL amyloidosis, 94% for those with ATTR amyloidosis, and 86% for those who received MCS bridging.
“In conclusion, careful patient selection and appropriate management of light chains and extracardiac disease can lead to reasonable short-term outcomes in select patients with end-stage CA undergoing cardiac transplantation,” the authors concluded. “Additionally, durable biventricular MCS is a suitable option for bridging these patients to cardiac transplant.”
This study was published in Transplantation Proceedings.