Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Can J Cardiol. 2022 Aug;38(8):1263-1270. doi: 10.1016/j.cjca.2022.04.023. Epub 2022 May 4.
Heart transplantation in patients with amyloid cardiomyopathy (ACM) has been historically underused owing to the risk of amyloid recurrence.
Using data from the United Network for Organ Sharing database on patients listed for single-organ heart transplant between 2010 and 2019, we evaluated trend in heart transplant and compared waitlist mortality and graft survival between patients with ACM and dilated cardiomyopathy (DCM). Also, we evaluated for independent predictors of outcomes.
Over the study period, 411 adult patients with ACM were added to the heart transplant waitlist. In the propensity-matched cohorts, the rates of waitlist mortality were significantly higher for ACM compared with DCM (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.16-2.65). Over the study period, 330 patients with ACM underwent heart transplant. The number of transplants increased from 22 in 2010 to 59 in 2019 (168% increase). The 5-year graft survival rate was, however, significantly worse for ACM (78%) compared with DCM (82%) (HR,1.46, 1.03-2.08). We identified 2 predictors of graft failure among patients with ACM: namely, renal failure requiring dialysis (HR, 5.4, 1.6-17) and previous history of malignancy (HR, 1.6, 1.0-28). Patients with ACM with neither risk factor had 5-year graft survivals of 82%, which is comparable with DCM (HR, 1.28, 0.90-1.91). On the other hand, patients with ACM and either risk factor had worse 5-year graft survivals of 62% (HR, 2.44, 1.39-4.28).
Increasing numbers of patients with ACM are undergoing heart transplants. Although patients with ACM experience higher waitlist mortality and worse graft survival compared with DCM, selecting carefully screened ACM patients may result in improved outcomes following heart transplant.
由于淀粉样变性心肌病（ACM）复发的风险，心脏移植在 ACM 患者中的应用历史上一直较少。
利用 2010 年至 2019 年期间在器官共享联合网络数据库中接受单器官心脏移植的患者数据，我们评估了心脏移植的趋势，并比较了 ACM 和扩张型心肌病（DCM）患者的等待名单死亡率和移植物存活率。此外，我们还评估了结果的独立预测因素。
在研究期间，411 名 ACM 成年患者被列入心脏移植等待名单。在倾向评分匹配队列中，ACM 患者的等待名单死亡率明显高于 DCM（风险比 [HR]，1.75；95%置信区间 [CI]，1.16-2.65）。在研究期间，330 名 ACM 患者接受了心脏移植。2010 年移植 22 例，2019 年增加到 59 例（增加 168%）。然而，ACM 的 5 年移植物存活率明显较差（78%），而 DCM 为 82%（HR，1.46，1.03-2.08）。我们在 ACM 患者中确定了 2 个移植物失败的预测因素：即需要透析的肾衰竭（HR，5.4，1.6-17）和既往恶性肿瘤病史（HR，1.6，1.0-28）。没有这两个危险因素的 ACM 患者 5 年移植物存活率为 82%，与 DCM 相当（HR，1.28，0.90-1.91）。另一方面，有这两个危险因素之一的 ACM 患者 5 年移植物存活率较差，为 62%（HR，2.44，1.39-4.28）。
越来越多的 ACM 患者正在接受心脏移植。尽管与 DCM 相比，ACM 患者的等待名单死亡率较高，移植物存活率较低，但仔细筛选 ACM 患者可能会改善心脏移植后的结果。
