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Cardiac transplantation in patients with transthyretin amyloid cardiomyopathy is associated with improved survival rates and quality of life and reduced risk of cardiac allograft amyloid recurrence.

Patients diagnosed with transthyretin amyloid cardiomyopathy (ATTR-CM) have limited treatment options, including cardiac transplantation. Despite comparable treatment outcomes with cardiac transplantation between non-amyloid cardiomyopathy and ATTR-CM patients, some centers consider ATTR-CM a contraindication to cardiac transplantation. This retrospective study concluded that this procedure is well-tolerated among ATTR-CM patients, restoring their functional capacity and improving prognosis. There is a low risk of recurrence of amyloid deposition in cardiac allograft in these patients. These findings are published in the journal Frontiers in Cardiovascular Medicine.

Excellent Outcomes of Cardiac Transplantation in ATTR-CM

According to this study, cardiac transplantation was associated with excellent treatment outcomes and survival rates that were comparable to those for patients who underwent cardiac transplantation indicated for non-amyloid cardiomyopathies. The one-year, three-year, and five-year survival rates in transplanted ATTR-CM patients were estimated to be 100%, 92%, and 90%, respectively.

Renal Impairment Following Cardiac Transplantation in ATTR-CM

Renal impairment post-cardiac transplantation is considered to be caused by perioperative hypoperfusion. In the given study, progressive chronic kidney disease was observed in 8/14 cardiac transplantation recipients. Three patients were required to undergo post-operative hemodialysis. Two of these patients recovered with normal renal function, whereas four patients suffered from chronic kidney disease. The last patient suffered from progressive chronic kidney disease, based on using a calcineurin inhibitor 12 years after undergoing cardiac transplantation.

Amyloid Deposition Recurrence in Cardiac Allograft

The patients underwent assessment regularly after cardiac transplantation for recurrence of graft amyloid using Tc-DPD scintigraphy or endomyocardial biopsies combined with cardiac magnetic resonance imaging. Despite 12/14 patients not receiving disease-modifying therapy for the recurrence of amyloidosis, none of the patients developed a recurrence of amyloid deposition in the cardiac allograft.

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This study concludes that cardiac transplantation is a useful therapeutic intervention for ATTR-CM patients that increases survival rates and improves quality of life. Cardiac transplantation is also associated with a negligible risk of developing cardiac allograft amyloid recurrence.

Source

Razvi, Y., Porcari, A., Di Nora, C., Patel, R. K., Ioannou, A., Rauf, M. U., Masi, A., Law, S., Chacko, L., Rezk, T., Ravichandran, S., Gilbertson, J., Rowczenio, D., Blakeney, I. J., Kaza, N., Hutt, D. F., Lachmann, H., Wechalekar, A., Moody, W., . . . Gillmore, J. D. (2022). Cardiac transplantation in transthyretin amyloid cardiomyopathy: Outcomes from three decades of tertiary center experience. Front Cardiovasc Med, 9, 1075806. https://doi.org/10.3389/fcvm.2022.1075806