Witteles Ronald M
Stanford Amyloid Center, Stanford University School of Medicine, Stanford, California, USA.
JACC CardioOncol. 2021 Oct 19;3(4):516-521. doi: 10.1016/j.jaccao.2021.05.007. eCollection 2021 Oct.
• Cardiac transplantation for amyloidosis was once considered contraindicated owing to unacceptably high morbidity/mortality rates. • Increased therapeutic options for AL and ATTR amyloidosis and improved pre-transplantation screening practices have led to markedly improved transplant outcomes over the past 10-15 years. • Mechanical circulatory support options remain limited but can be considered in selected patients, particularly for those with larger ventricular cavities. • Transplant prioritization rules may need to be reconsidered for amyloidosis patients to adequately prioritize AL amyloidosis patients, who are at increased risk of pre-transplantation mortality.
• 由于发病率/死亡率高得令人难以接受，心脏移植曾被认为不适用于淀粉样变性患者。
• 在过去10至15年中，AL和ATTR淀粉样变性的治疗选择增加，以及移植前筛查方法的改进，使得移植结果有了显著改善。
• 机械循环支持选择仍然有限，但可以考虑用于特定患者，特别是那些心室腔较大的患者。
• 可能需要重新考虑淀粉样变性患者的移植优先排序规则，以便充分优先考虑移植前死亡风险增加的AL淀粉样变性患者。
