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State-of-the-art review on management of end-stage heart failure in amyloidosis: transplant and beyond

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Abstract

Cardiac involvement occurs in light-chain (AL), transthyretin wild-type (wtATTR), and hereditary (hATTR) amyloidosis; other types of amyloidosis account for < 5% of all cardiac amyloidosis (CA). CA can present subclinically on screening, insidiously with symptoms such as exertional dyspnea, or abruptly as cardiogenic shock. Initially, CA patients were thought to be poor candidates for transplant due to short long-term survival; however, there is a marked improvement in heart and multi-organ transplant outcomes over the past 10 years with newer treatments and improvements in support with temporary and durable mechanical circulatory support while awaiting transplant. Patients with AL CA were reported to have worse post-OHT outcomes than patients with ATTR CA, but this gap is quickly closing with improved patient selection, novel chemotherapeutics, and perhaps with selected use of bone marrow transplantation. Waitlist mortality and transplantation rates have markedly improved for CA after the United Network for Organ Sharing (UNOS) policy change in October 2018. In this review, we will evaluate contemporary data from the last 5 years on advances in the field of transplantation and mechanical circulatory support in this patient population.

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Abbreviations

hATTR:

Hereditary transthyretin amyloidosis

wtATTR:

Wild-type transthyretin amyloidosis

AL:

Light-chain amyloidosis

TAH:

Total artificial heart

LVAD:

Left ventricular assist device

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Acknowledgements

The authors would like to acknowledge Ms. Amy Taylor, our Houston Methodist medical librarian, for helping us systematically query medical databases for our review’s references.

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Authors and Affiliations

  1. Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA

    Salil Kumar & Barry Trachtenberg

  2. Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA

    Daniel Li & Denny Joseph

  3. Houston Methodist J.C. Walter Jr. Transplant Center, Houston, TX, USA

    Barry Trachtenberg

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  1. Salil Kumar
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  2. Daniel Li
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  4. Barry Trachtenberg
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Contributions

Review conception and design: SK, DL, and BT. Data collection and citation review: SK, DL, and DJ. Manuscript draft: SK, DL, BT, and DJ. Critical review: SK, DL, and BT.

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Correspondence to Barry Trachtenberg.

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B.T. has consulting agreements with Pfizer and is a speaker for Pfizer, Akcea, and Alynlam. The rest of the authors, SK, DL, and DJ have nothing to disclose.

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Kumar, S., Li, D., Joseph, D. et al. State-of-the-art review on management of end-stage heart failure in amyloidosis: transplant and beyond. Heart Fail Rev 27, 1567–1578 (2022). https://doi.org/10.1007/s10741-021-10209-3

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