Cardiac transplantation using extended-donor criteria organs for systemic amyloidosis complicated by heart failure

Mathew S. Maurer, Amresh Raina, Charles Hesdorffer, Rachel Bijou, Paolo Colombo, Mario Deng, Ronald Drusin, Jennifer Haythe, Evelyn Horn, Sun Hi Lee, Charles Marboe, Yoshifumi Naka, Larry Schulman, Brian Scully, Peter Shapiro, Kenneth Prager, Jai Radhakrishnan, Susan Restaino, Donna Mancini

Research output: Contribution to journalArticle

Abstract

BACKGROUND. Systemic amyloidosis complicated by heart failure is associated with high cardiovascular morbidity and mortality. Heart transplantation for patients with systemic amyloidosis is controversial due to recurrence of disease in the transplanted organ or progression of disease in other organs. METHODS. All patients with systemic amyloidosis and heart failure referred for heart transplant evaluation from 1997 to 2004 were included in this retrospective cohort analysis. An interdisciplinary protocol for cardiac transplantation using extended-donor criteria organs, followed in 6 months by either high-dose chemotherapy and stem cell transplantation for patients with primary (AL) or by orthotopic liver transplantation for familial (ATTR) amyloidosis, was developed. Survival of the transplanted amyloid cohort was compared to survival of those amyloid patients not transplanted and to patients transplanted for other indications. RESULTS. A total of 25 patients with systemic amyloidosis and heart failure were included in the study; 12 patients received heart transplants. Amyloid heart transplant recipients were more likely female (58% vs. 8%, P=0.02) and had lower serum creatinine (1.3±0.5 vs. 2.0±0.7 mg/dL, P=0.01) than nontransplanted amyloid patients. Survival at 1-year after heart transplant evaluation was higher among transplanted patients (75% vs. 23%) compared to patients not transplanted (P=0.001). Short-term survival posttransplant did not differ between transplanted amyloid patients and contemporaneous standard and extended-donor criteria heart transplant patients (P=0.65). CONCLUSIONS. Cardiac transplantation for amyloid patients with extended-donor criteria organs followed by either stem cell or liver transplantation is associated with improved survival compared to patients not transplanted. Short- to intermediate-term survival is similar to patients receiving heart transplantation for other indications. This clinical management strategy provides cardiac amyloid patients a novel therapeutic option.

Original languageEnglish (US)
Pages (from-to)539-545
Number of pages7
JournalTransplantation
Volume83
Issue number5
DOIs
StatePublished - Mar 2007
Externally publishedYes

Fingerprint

Amyloidosis
Heart Transplantation
Heart Failure
Tissue Donors
Amyloid
Survival
Transplants
Stem Cell Transplantation
Liver Transplantation
Familial Amyloidosis
Disease Progression

Keywords

  • Amyloid
  • Cardiac transplantation
  • Extended donor criteria
  • Stem cell transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Maurer, M. S., Raina, A., Hesdorffer, C., Bijou, R., Colombo, P., Deng, M., ... Mancini, D. (2007). Cardiac transplantation using extended-donor criteria organs for systemic amyloidosis complicated by heart failure. Transplantation, 83(5), 539-545. https://doi.org/10.1097/01.tp.0000255567.80203.bd

Cardiac transplantation using extended-donor criteria organs for systemic amyloidosis complicated by heart failure. / Maurer, Mathew S.; Raina, Amresh; Hesdorffer, Charles; Bijou, Rachel; Colombo, Paolo; Deng, Mario; Drusin, Ronald; Haythe, Jennifer; Horn, Evelyn; Lee, Sun Hi; Marboe, Charles; Naka, Yoshifumi; Schulman, Larry; Scully, Brian; Shapiro, Peter; Prager, Kenneth; Radhakrishnan, Jai; Restaino, Susan; Mancini, Donna.

In: Transplantation, Vol. 83, No. 5, 03.2007, p. 539-545.

Research output: Contribution to journalArticle

Maurer, MS, Raina, A, Hesdorffer, C, Bijou, R, Colombo, P, Deng, M, Drusin, R, Haythe, J, Horn, E, Lee, SH, Marboe, C, Naka, Y, Schulman, L, Scully, B, Shapiro, P, Prager, K, Radhakrishnan, J, Restaino, S & Mancini, D 2007, 'Cardiac transplantation using extended-donor criteria organs for systemic amyloidosis complicated by heart failure', Transplantation, vol. 83, no. 5, pp. 539-545. https://doi.org/10.1097/01.tp.0000255567.80203.bd
Maurer, Mathew S. ; Raina, Amresh ; Hesdorffer, Charles ; Bijou, Rachel ; Colombo, Paolo ; Deng, Mario ; Drusin, Ronald ; Haythe, Jennifer ; Horn, Evelyn ; Lee, Sun Hi ; Marboe, Charles ; Naka, Yoshifumi ; Schulman, Larry ; Scully, Brian ; Shapiro, Peter ; Prager, Kenneth ; Radhakrishnan, Jai ; Restaino, Susan ; Mancini, Donna. / Cardiac transplantation using extended-donor criteria organs for systemic amyloidosis complicated by heart failure. In: Transplantation. 2007 ; Vol. 83, No. 5. pp. 539-545.
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abstract = "BACKGROUND. Systemic amyloidosis complicated by heart failure is associated with high cardiovascular morbidity and mortality. Heart transplantation for patients with systemic amyloidosis is controversial due to recurrence of disease in the transplanted organ or progression of disease in other organs. METHODS. All patients with systemic amyloidosis and heart failure referred for heart transplant evaluation from 1997 to 2004 were included in this retrospective cohort analysis. An interdisciplinary protocol for cardiac transplantation using extended-donor criteria organs, followed in 6 months by either high-dose chemotherapy and stem cell transplantation for patients with primary (AL) or by orthotopic liver transplantation for familial (ATTR) amyloidosis, was developed. Survival of the transplanted amyloid cohort was compared to survival of those amyloid patients not transplanted and to patients transplanted for other indications. RESULTS. A total of 25 patients with systemic amyloidosis and heart failure were included in the study; 12 patients received heart transplants. Amyloid heart transplant recipients were more likely female (58{\%} vs. 8{\%}, P=0.02) and had lower serum creatinine (1.3±0.5 vs. 2.0±0.7 mg/dL, P=0.01) than nontransplanted amyloid patients. Survival at 1-year after heart transplant evaluation was higher among transplanted patients (75{\%} vs. 23{\%}) compared to patients not transplanted (P=0.001). Short-term survival posttransplant did not differ between transplanted amyloid patients and contemporaneous standard and extended-donor criteria heart transplant patients (P=0.65). CONCLUSIONS. Cardiac transplantation for amyloid patients with extended-donor criteria organs followed by either stem cell or liver transplantation is associated with improved survival compared to patients not transplanted. Short- to intermediate-term survival is similar to patients receiving heart transplantation for other indications. This clinical management strategy provides cardiac amyloid patients a novel therapeutic option.",
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T1 - Cardiac transplantation using extended-donor criteria organs for systemic amyloidosis complicated by heart failure

AU - Maurer, Mathew S.

AU - Raina, Amresh

AU - Hesdorffer, Charles

AU - Bijou, Rachel

AU - Colombo, Paolo

AU - Deng, Mario

AU - Drusin, Ronald

AU - Haythe, Jennifer

AU - Horn, Evelyn

AU - Lee, Sun Hi

AU - Marboe, Charles

AU - Naka, Yoshifumi

AU - Schulman, Larry

AU - Scully, Brian

AU - Shapiro, Peter

AU - Prager, Kenneth

AU - Radhakrishnan, Jai

AU - Restaino, Susan

AU - Mancini, Donna

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N2 - BACKGROUND. Systemic amyloidosis complicated by heart failure is associated with high cardiovascular morbidity and mortality. Heart transplantation for patients with systemic amyloidosis is controversial due to recurrence of disease in the transplanted organ or progression of disease in other organs. METHODS. All patients with systemic amyloidosis and heart failure referred for heart transplant evaluation from 1997 to 2004 were included in this retrospective cohort analysis. An interdisciplinary protocol for cardiac transplantation using extended-donor criteria organs, followed in 6 months by either high-dose chemotherapy and stem cell transplantation for patients with primary (AL) or by orthotopic liver transplantation for familial (ATTR) amyloidosis, was developed. Survival of the transplanted amyloid cohort was compared to survival of those amyloid patients not transplanted and to patients transplanted for other indications. RESULTS. A total of 25 patients with systemic amyloidosis and heart failure were included in the study; 12 patients received heart transplants. Amyloid heart transplant recipients were more likely female (58% vs. 8%, P=0.02) and had lower serum creatinine (1.3±0.5 vs. 2.0±0.7 mg/dL, P=0.01) than nontransplanted amyloid patients. Survival at 1-year after heart transplant evaluation was higher among transplanted patients (75% vs. 23%) compared to patients not transplanted (P=0.001). Short-term survival posttransplant did not differ between transplanted amyloid patients and contemporaneous standard and extended-donor criteria heart transplant patients (P=0.65). CONCLUSIONS. Cardiac transplantation for amyloid patients with extended-donor criteria organs followed by either stem cell or liver transplantation is associated with improved survival compared to patients not transplanted. Short- to intermediate-term survival is similar to patients receiving heart transplantation for other indications. This clinical management strategy provides cardiac amyloid patients a novel therapeutic option.

AB - BACKGROUND. Systemic amyloidosis complicated by heart failure is associated with high cardiovascular morbidity and mortality. Heart transplantation for patients with systemic amyloidosis is controversial due to recurrence of disease in the transplanted organ or progression of disease in other organs. METHODS. All patients with systemic amyloidosis and heart failure referred for heart transplant evaluation from 1997 to 2004 were included in this retrospective cohort analysis. An interdisciplinary protocol for cardiac transplantation using extended-donor criteria organs, followed in 6 months by either high-dose chemotherapy and stem cell transplantation for patients with primary (AL) or by orthotopic liver transplantation for familial (ATTR) amyloidosis, was developed. Survival of the transplanted amyloid cohort was compared to survival of those amyloid patients not transplanted and to patients transplanted for other indications. RESULTS. A total of 25 patients with systemic amyloidosis and heart failure were included in the study; 12 patients received heart transplants. Amyloid heart transplant recipients were more likely female (58% vs. 8%, P=0.02) and had lower serum creatinine (1.3±0.5 vs. 2.0±0.7 mg/dL, P=0.01) than nontransplanted amyloid patients. Survival at 1-year after heart transplant evaluation was higher among transplanted patients (75% vs. 23%) compared to patients not transplanted (P=0.001). Short-term survival posttransplant did not differ between transplanted amyloid patients and contemporaneous standard and extended-donor criteria heart transplant patients (P=0.65). CONCLUSIONS. Cardiac transplantation for amyloid patients with extended-donor criteria organs followed by either stem cell or liver transplantation is associated with improved survival compared to patients not transplanted. Short- to intermediate-term survival is similar to patients receiving heart transplantation for other indications. This clinical management strategy provides cardiac amyloid patients a novel therapeutic option.

KW - Amyloid

KW - Cardiac transplantation

KW - Extended donor criteria

KW - Stem cell transplantation

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