Predictors of survival to orthotopic heart transplant in patients with light chain amyloidosis

Gilstrap, Lauren; Niehaus, Emily; Malhotra, Rajeev; Ton, Van-Khue; Watts, James A.; Seldin, David C.; Madsen, Joren C.; Semigran, Marc J.

doi:10.1016/j.healun.2013.09.004

Cited by 69 publications

(56 citation statements)

References 31 publications

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“…Recent reports suggest improved short term outcomes with advances in chemotherapy and AHSCT, with the Stanford series reporting 1 year survival of 100% [20] . In the MGH series of 18 AL patients undergoing OHT approximately 60% of patients were alive at 6 years [10] , and, in contrast to earlier studies [8,9,21] , was similar to that of nonamyloid patients. Although overall survival in our study was reduced compared with patients transplanted for nonamyloid indications, our series includes many early era patients who did not receive the benefit of current therapy for amyloidosis.…”

Section: Discussionmentioning

confidence: 48%

“…Time is of the essence in these patients. In our experience and others, approximately 40% of AL patients listed do not undergo OHT either due to death or deterioration [10] . This seems to be related to both delayed diagnosis, as well as inability to support these patients with traditional heart failure therapy and devices.…”

Section: Discussionmentioning

confidence: 50%

“…Perhaps cardiac biomarkers like ST2 may lend insight to those with irreparable damage despite effective chemotherapy [26] . "Better selection" also means choosing those patients in whom the underlying plasma cell clone can be controlled, since in our study and others effective chemotherapy has resulted in the best outcomes post OHT [10,16,20] . Most of the patients in our series did not receive chemotherapy prior to OHT because the only chemotherapies available at the time of their diagnosis were oral melphalan and prednisone and high dose melphalan with AHSCT.…”

Section: Discussionmentioning

confidence: 70%

“…This seems to be related to both delayed diagnosis, as well as inability to support these patients with traditional heart failure therapy and devices. In the MGH series, patients with amyloidosis had a mortality hazard ratio of 4.7 (95%CI: 2.8, 11.8) as compared to nonamyloidosis patients while on the waiting list [10] . The only predictive factor of survival to OHT in that study was BMI patients with lower BMI fared better than those with higher BMI, although this was not confirmed in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Orthotopic heart transplantation (OHT) in AL has been limited due to the risk of disease progression in other organs and recurrence of amyloid deposition in the transplanted heart [7,8] . Although earlier studies suggested inferior outcomes of OHT for compared with nonamyloid indications [8,9] , more recent reports have found survival similar to other forms of heart failure [10] . Controversy regarding the role of OHT in AL remains [11,12] and many centers consider amyloidosis to be a contraindication to OHT.…”

Section: Introductionmentioning

confidence: 94%

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Long term outcomes of cardiac transplant for immunoglobulin light chain amyloidosis: The Mayo Clinic experience

Grogan¹,

Gertz²,

McCurdy³

et al. 2016

WJT

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AIM:To determine the outcome of orthotopic heart transplantation (OHT) in immunoglobulin light chain (AL) amyloidosis. METHODS:The medical records of patients with AL who underwent orthotopic heart transplantation at the Mayo Clinic in Rochester Minnesota from 1992 to 2011 were reviewed. Patients met at least one of the following at: New York Heart Association class Ⅳ heart failure, ventricular thickness > 15 mm, ejection fraction < 40%. Selection guidelines for heart transplant included age < 60 years, absence of multiple myeloma and significant extra-cardiac organ involvement. Baseline characteristics including age, gender, organ years).The 1-year survival post OHT was 77%, the 2-year survival 65%, and the 5-year survival 43%. The 5-year survival for non-amyloid patients undergoing OHT during the same era was 85%. Progressive amyloidosis contributed to death in twelve patients. Of those without evidence of progressive amyloidosis, the cause of death included complications of autologous hematopoietic stem cell transplantation for 3 patients, post-transplant lymphoproliferative disorder for 2 patients; and for the remaining one death was related to each of the following causes: acute rejection; cardiac vasculopathy; metastatic melanoma; myelodysplastic syndrome; and unknown. Eight patients had rejection at a median of 1.8 mo post OHT (range 0.4 to 4.9 mo); only one patient died of rejection. Median survival of seven patients who achieved a complete hematologic response to either chemotherapy or autologous hematopoietic stem cell transplantation was 10.8 years.CONCLUSION: Our data demonstrate that long term survival after heart transplant is feasible in AL patients with limited extra-cardiac involvement who achieve complete hematologic response.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

See 3 more Smart Citations

Long term outcomes of cardiac transplant for immunoglobulin light chain amyloidosis: The Mayo Clinic experience

Grogan¹,

Gertz²,

McCurdy³

et al. 2016

WJT

View full text Add to dashboard Cite

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The Multidisciplinary Recipient Selection Process (Adult and Pediatric): Inclusion and Exclusion Criteria

Vaidya,

Kobashigawa

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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A new staging system using right atrial strain in patients with immunoglobulin light‐chain cardiac amyloidosis

Usuku,

Yamamoto,

Sueta

et al. 2024

ESC Heart Failure

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AimsThere are minimal data on the prognostic impact of right atrial strain during the reservoir phase (RASr) in patients with immunoglobulin light‐chain (AL) cardiac amyloidosis.Methods and resultsAmong 78 patients who were diagnosed with AL cardiac amyloidosis at Kumamoto University Hospital from 2007 to 2022, 72 patients with sufficient two‐dimensional speckle tracking imaging data without chemotherapy before the diagnosis were retrospectively analysed. During a median follow‐up of 403 days, 31 deaths occurred. Age and the rate of male sex were not significantly different between the all‐cause death group and the survival group (age, 70.4 ± 8.8 years vs. 67.0 ± 10.0 years, P = 0.14, male sex, 65% vs. 66%, P = 0.91). The estimated glomerular filtration rate (eGFR) was significantly lower, and B‐type natriuretic peptide (BNP) and high sensitivity cardiac troponin T (hs‐cTnT) were significantly higher, in the all‐cause death group versus the survival group (eGFR, 48.2 ± 21.0 mL/min/1.73 m2 vs. 59.4 ± 24.4 mL/min/1.73 m2, P < 0.05, BNP, 725 [360–1312] pg/mL vs. 123 [81–310] pg/mL, P < 0.01, hs‐cTnT, 0.12 [0.07–0.18] ng/mL vs. 0.05 [0.03–0.08] ng/mL, P < 0.01). Left ventricular (LV) global longitudinal strain (GLS) (LV‐GLS), left atrial strain during the reservoir phase (LASr), right ventricular GLS (RV‐GLS), and RASr were significantly lower in the all‐cause death group versus the survival group (LV‐GLS, 8.5 ± 4.3% vs. 11.8 ± 3.8%, P < 0.01, LASr, 8.8 ± 7.1% vs. 14.3 ± 8.1%, P < 0.01, RV‐GLS, 11.6 ± 5.1% vs. 16.4 ± 3.9%, P < 0.01, RASr, 10.2 ± 7.3% vs. 20.7 ± 9.5%, P < 0.01). RASr was significantly associated with all‐cause death after adjusting for RV‐GLS, LV‐GLS and LASr (hazard ratio [HR]: 0.91, 95% confidence interval [95% CI]: 0.83–0.99, P < 0.05). RASr and log‐transformed BNP were significantly associated with all‐cause death after adjusting for log‐transformed troponin T and eGFR (RASr, HR: 0.93, 95% CI: 0.87–1.00, P < 0.05; log‐transformed BNP, HR: 2.10, 95% CI: 1.17–3.79, P < 0.05). The optimal cut‐off values were RASr: 16.4% (sensitivity: 66%, specificity: 84%, area under curve [AUC]: 0.81) and BNP: 311.2 pg/mL (sensitivity: 83%, specificity: 78%, AUC: 0.82) to predict all‐cause mortality using ROC analysis. Kaplan–Meier analysis revealed that patients with low RASr (<16.4%) or high BNP (>311.2 pg/mL) had a significantly high probability of all‐cause death (both, P < 0.01). We devised a new staging score by adding 1 point if RASr decreased or BNP levels increased more than each cut‐off value. The HR for all‐cause death using score 0 as a reference was 5.95 (95% CI: 1.19–29.79; P < 0.05) for score 1 and 23.29 (95% CI: 5.37–100.98; P < 0.01) for score 2.ConclusionsThe new staging system using RASr and BNP predicted prognosis in patients with AL cardiac amyloidosis.

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Predictors of survival to orthotopic heart transplant in patients with light chain amyloidosis

Cited by 69 publications

References 31 publications

Long term outcomes of cardiac transplant for immunoglobulin light chain amyloidosis: The Mayo Clinic experience

Long term outcomes of cardiac transplant for immunoglobulin light chain amyloidosis: The Mayo Clinic experience

The Multidisciplinary Recipient Selection Process (Adult and Pediatric): Inclusion and Exclusion Criteria

A new staging system using right atrial strain in patients with immunoglobulin light‐chain cardiac amyloidosis

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