To use or not to use? Amiodarone before heart transplantation

Lushaj, Entela B.; Dhingra, Ravi; Chindhy, Shahzad; Akhter, Shahab A.; Kohmoto, Takushi; Ulschmid, S.; Osaki, Satoru; Badami, Abbasali; Lozonschi, Lucian

doi:10.1016/j.surg.2016.09.034

Cited by 12 publications

(11 citation statements)

References 31 publications

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“…The data evaluating the effect of amiodarone on mortality and the development of PGD after OHT remains mixed. One study found an increase in the incidence of PGD but no significant difference in 30‐day or 1‐year post‐transplantation survival while another study found preOHT amiodarone treatment not to be associated with increased mortality after OHT . Conversely, a separate group found preOHT amiodarone treatment to have a higher incidence of 1‐year mortality but no significant incidence of early graft failure .…”

Section: Discussionmentioning

confidence: 99%

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Hoemann

Takayama

Jennings

et al. 2020

Clinical Transplantation

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Background Recent studies have shown an increased incidence of primary graft dysfunction (PGD) in patients treated with amiodarone prior to orthotopic heart transplant (OHT). We hypothesized that discontinuation of amiodarone before OHT may lower the incidence of severe PGD. Methods This was a single‐center retrospective study of 381 adult OHT recipients between January 2010 and June 2017. Within 6 months prior to OHT, 197 did not receive amiodarone (Group 1), 142 continued amiodarone to OHT (Group 2), and 42 had amiodarone treatment discontinued before OHT (Group 3). Results 53 (13.9%) participants developed severe PGD, 13 (6.6%) of which were in Group 1, 36 (25.4%) were in Group 2, and 4 (9.5%) were in Group 3 (P < .001). Multivariable analysis revealed continued amiodarone treatment to OHT (Group 2; OR, 3.70; 95% CI, 1.26‐10.88; P = .018) to be an independent risk factor for the development of severe PGD when Group 1 served as the reference group. Moreover, patients in Group 3 had no difference in the risk of severe PGD (OR = 0.416, 95% CI = 0.08‐2.15; P = .296). Conclusion We found that discontinuing amiodarone treatment prior to OHT resulted a lower incidence of severe PGD.

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Section: Discussionmentioning

confidence: 99%

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Hoemann

Takayama

Jennings

et al. 2020

Clinical Transplantation

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“…We observed a lower percentage of 30‐day post‐transplant AF in patients receiving amiodarone with (4.5%) or without digitalis before HTX (7.8%) in comparison with patients with no amiodarone before HTX (14.7%, P = 0.03). Lushaj and colleagues 5 found no difference between patients with (6.5%) or without (7.1%, P = 0.76) amiodarone before HTX regarding post‐transplant AF, which could be a result of their lower overall incidence of post‐transplant AF (6.8%). A recent Cochrane meta‐analysis 47 reported a higher overall incidence of AF after HTX of 10.1%, which is in line with our findings.…”

Section: Discussionmentioning

confidence: 94%

“…Amiodarone is a frequently used drug for the treatment of life-threatening arrhythmias in patients with end-stage heart failure (HF) awaiting heart transplantation (HTX). [1][2][3][4][5] In patients with long-term use, amiodarone is extensively distributed into the body's tissues resulting in a reported half-life of about 3 months. [6][7][8][9] As a result of this long half-life, the cardiac allograft is exposed to a certain degree of amiodarone in the early post-transplant period.…”

Section: Introductionmentioning

confidence: 99%

Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality

et al. 2020

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Aims Amiodarone and digitalis are frequently used drugs in patients with heart failure. Both have separately been linked to reduced post-transplant survival, but their combined impact on mortality after HTX remains uncertain. This study investigated the effects of combined amiodarone and digitalis use before HTX on post-transplant outcomes. Methods and results This registry study analysed 600 patients receiving HTX at Heidelberg Heart Center between 1989 and 2016. Patients were stratified by amiodarone and digitalis use before HTX. Analysis included patient characteristics, medication, echocardiographic features, heart rates, permanent pacemaker implantation, atrial fibrillation, and post-transplant survival including causes of death. One hundred eighteen patients received amiodarone before HTX (19.7%), hereof 67 patients with digitalis (56.8%) and 51 patients without digitalis before HTX (43.2%). Patients with and without amiodarone before HTX showed a similar 1 year post-transplant survival (72.0% vs. 78.4%, P = 0.11), but patients with combined amiodarone and digitalis before HTX had a worse 1 year post-transplant survival (64.2%, P = 0.01), along with a higher percentage of death due to transplant failure (P = 0.03). Echocardiographic analysis of these patients showed a higher percentage of an enlarged right ventricle (P = 0.02), left atrium (P = 0.02), left ventricle (P = 0.03), and a higher rate of reduced left ventricular ejection fraction (P = 0.03). Multivariate analysis indicated combined amiodarone and digitalis use before HTX as a significant risk factor for 1 year mortality after HTX (hazard ratio: 1.69; 95% confidence interval: 1.02-2.77; P = 0.04). Conclusions Combined pre-transplant amiodarone and digitalis therapy is associated with increased post-transplant mortality.

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“…Amiodarone use in heart transplant recipients Wright et al, 41 Lushaj et al, 42 Rivinius et al 43 Possible association between chronic pre-CTX use of amiodarone and decreased long-term (not early) survival. Possible decreased incidence of atrial fibrillation.…”

Section: Topic Authors Findingsmentioning

confidence: 99%

“…Lushaj et al 42 analyzed 220 consecutive heart transplant recipients at a single institution (performed between January 2004 and December 2015). When comparing patients not taking amiodarone with those taking amiodarone for at least 120 days before heart transplantation, the latter group had higher incidence of PGD (4% vs 0%; P = .025) and posttransplant pneumonia ( P = .047).…”

Section: Noteworthy Literature Published In 2017 On Cardiac Transplanmentioning

confidence: 99%

Noteworthy Literature Published in 2017 for Thoracic Transplantation Anesthesiologists

Rio

Maerz

Subramaniam

2018

Semin Cardiothorac Vasc Anesth

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To use or not to use? Amiodarone before heart transplantation

Cited by 12 publications

References 31 publications

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality

Noteworthy Literature Published in 2017 for Thoracic Transplantation Anesthesiologists

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