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Outcomes of heart transplantation in cardiac amyloidosis: an updated systematic review

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Abstract

Cardiac amyloidosis is one of the most common infiltrative cardiomyopathies that is characterized by the extracellular deposition of misfolded fibrillar protein. Several studies have previously found that patients with amyloid in the past have performed poorly after heart transplantation. Recent advancements in treatments have been made that have significantly improved outcomes in these patients. The study aimed to evaluate the outcomes of heart transplantation in cardiac amyloidosis. We systematically searched EMBASE, PubMed/MEDLINE, and Cochrane Library databases on 30 December 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We identified 22 studies that examined 42,951 patients with cardiac amyloidosis of which only 1,329 patients underwent isolated heart transplantation. Seven studies reported individual patient data. The results of 123 patients have been pooled for analysis. There were 70 male patients, 45 female patients, and eight patients who did not report their gender. Among the types of amyloids, 63 (51%) patients were found to have light chain amyloidosis (AL) and 33 (27%) patients had transthyretin amyloidosis (ATTR). Only 41 patients (33.3%) reported a monoclonal component. There were 30 patients with AL that underwent autologous hematopoietic stem cell transplant (ASCT). The mean survival of 24 out of 30 patients was 4.33 years. In addition, the reported data include 13 patients requiring intra-aortic balloon pump (IABP), six with cardiac resynchronization therapy (CRT), and four with implantable cardioverter defibrillator (ICD). With the current advancements in treatments in combination with a multidisciplinary approach and careful patient selection, patients undergoing heart transplantation for amyloidosis may have encouraging results in the current era. Further studies will be needed to evaluate the outcomes of heart transplantation in amyloidosis patients now that several advances have been made in the field.

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References

  1. Blancas-Mejía LM, Ramirez-Alvarado M (2013) Systemic amyloidosis. Annu Rev Biochem 82:745–74. https://doi.org/10.1146/annurev-biochem-072611-130030. (Epub 2013 Feb 28. PMID: 23451869; PMCID: PMC4044913)

  2. González-López E, López-Sainz Á, Garcia-Pavia P (2017) Diagnosis and treatment of transthyretin cardiac amyloidosis. Progress and Hope Rev Esp Cardiol (Engl Ed) 70(11):991–1004. https://doi.org/10.1016/j.rec.2017.05.036

    Article  Google Scholar 

  3. Tahir UA, Doros G, Kim JS et al (2019) Predictors of mortality in light chain cardiac amyloidosis with heart failure. Sci Rep 9(1):8552. https://doi.org/10.1038/s41598-019-44912-x. (Published 12 Jun 2019)

  4. Ruberg FL, Grogan M, Hanna M et al (2019) Transthyretin amyloid cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 73(22):2872–2891. https://doi.org/10.1016/j.jacc.2019.04.003.PMID:31171094;PMCID:PMC6724183

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kittleson MM, Maurer MS, Ambardekar AV et al (2021) Cardiac amyloidosis: evolving diagnosis and management: a scientific statement from the American Heart Association [published correction appears in Circulation 144(1):e11]. Circulation 142(1):e7-e22. https://doi.org/10.1161/CIR.0000000000000792

  6. Gilstrap LG et al (2019) Epidemiology of cardiac amyloidosis–associated heart failure hospitalizations among fee-for-service medicare beneficiaries in the United States. Circulation 12(6). https://doi.org/10.1161/circheartfailure.118.005407

  7. Witteles RM, Bokhari S, Damy T et al (2019) Screening for transthyretin amyloid cardiomyopathy in everyday practice. JACC Heart Fail 7(8):709–716. https://doi.org/10.1016/j.jchf.2019.04.010

    Article  PubMed  Google Scholar 

  8. Dubrey SW et al (2001) Long term results of heart transplantation in patiechrsnts with amyloid heart disease. Heart 85(2):202–207

    Article  CAS  Google Scholar 

  9. Ohiomoba RO et al (2021) Cardiac transplantation outcomes in patients with amyloid cardiomyopathy. Am Heart J 236:13–21

    Article  CAS  Google Scholar 

  10. Barrett CD, Alexander KM, Zhao H et al (2020) Outcomes in patients with cardiac amyloidosis undergoing heart transplantation. JACC Heart Fail 8(6):461–468. https://doi.org/10.1016/j.jchf.2019.12.013. (Epub 2020 May 6 PMID: 32387068)

    Article  PubMed  Google Scholar 

  11. Rosenbaum AN, Edwards BS (2015) Current indications, strategies, and outcomes with cardiac transplantation for cardiac amyloidosis and sarcoidosis. Curr Opin Organ Transplant 20(5):584–92. https://doi.org/10.1097/MOT.0000000000000229

  12. aus dem Siepen F, Hein S, Bauer R et al (2017) Standard heart failure medication in cardiac transthyretin amyloidosis: useful or harmful? Amyloid 24(sup1):132–133. https://doi.org/10.1080/13506129.2016.1272453

  13. Griffin JM, Rosenthal JL, Grodin JL et al (2021) ATTR amyloidosis: current and emerging management strategies: JACC: Cardio Oncology State-of-the-Art Review. JACC Cardio Oncol 3(4):488–505. https://doi.org/10.1016/j.jaccao.2021.06.006. (Published 19 Oct 2021)

  14. Dubrey SW, Burke MM, Hawkins PN et al (2004) Cardiac transplantation for amyloid heart disease: the United Kingdom experience. J Heart Lung Transplant 23(10):1142–1153

    Article  Google Scholar 

  15. Pelosi F Jr, Capehart J, Roberts WC (1997) Effectiveness of cardiac transplantation for primary (AL) cardiac amyloidosis. Am J Cardiol 79(4):532–535

    Article  Google Scholar 

  16. Lacy MQ, Dispenzieri A, Hayman SR et al (2008) Autologous stem cell transplant after heart transplant for light chain (Al) amyloid cardiomyopathy. J Heart Lung Transplant 27(8):823–829. https://doi.org/10.1016/j.healun.2008.05.016. (Epub 2008 Jul 3 PMID: 18656793)

    Article  PubMed  Google Scholar 

  17. Davis MK, Kale P, Liedtke M et al (2015) Outcomes after heart transplantation for amyloid cardiomyopathy in the modern era. Am J Transplant 15:650–658

    Article  CAS  Google Scholar 

  18. Bradshaw SH, Veinot JP (2012) Cardiac amyloidosis: what are the indications for transplant? Curr Opin Cardiol 27(2):143–147. https://doi.org/10.1097/HCO.0b013e32834fdc7e

    Article  PubMed  Google Scholar 

  19. Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, Danziger-Isakov L, Kirklin JK, Kirk R, Kushwaha SS, Lund LH, Potena L, Ross HJ, Taylor DO, Verschuuren EAM, Zuckermann A (2016) International Society for Heart Lung Transplantation (ISHLT) Infectious Diseases, Pediatric and Heart Failure and Transplantation Councils. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant 35(1):1–23. https://doi.org/10.1016/j.healun.2015.10.023. (PMID: 26776864)

  20. Maurer MS, Schwartz JH, Gundapaneni B et al (2018) Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med 379(11):1007–1016. https://doi.org/10.1056/NEJMoa1805689

    Article  CAS  PubMed  Google Scholar 

  21. Muchtar E, Gertz MA, Kumar SK, Lacy MQ, Dingli D, Buadi FK, Grogan M, Hayman SR, Kapoor P, Leung N, Fonder A, Hobbs M, Hwa YL, Gonsalves W, Warsame R, Kourelis TV, Russell S, Lust JA, Lin Y, Go RS, Zeldenrust S, Kyle RA, Rajkumar SV, Dispenzieri A (2017) Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014: cracking the glass ceiling of early death. Blood 129(15):2111–2119. https://doi.org/10.1182/blood-2016-11-751628. (Epub 2017 Jan 26. PMID: 28126928; PMCID: PMC5391625)

  22. Jain T, Kosiorek HE, Kung ST, Shah VS, Dueck AC, Gonzalez-Calle V, Luft S, Reeder CB, Adams R, Noel P, Larsen JT, Mikhael J, Bergsagel L, Stewart AK, Fonseca R (2018) Treatment with bortezomib-based therapy, followed by autologous stem cell transplantation, improves outcomes in light chain amyloidosis: a retrospective study. Clin Lymphoma Myeloma Leuk 18(7):486-492.e1. https://doi.org/10.1016/j.clml.2018.04.006. (Epub 2018 May 4 PMID: 29753692)

    Article  PubMed  Google Scholar 

  23. Dispenzieri A, Kyle RA, Lacy MQ, Therneau TM, Larson DR, Plevak MF, Rajkumar SV, Fonseca R, Greipp PR, Witzig TE, Lust JA, Zeldenrust SR, Snow DS, Hayman SR, Litzow MR, Gastineau DA, Tefferi A, Inwards DJ, Micallef IN, Ansell SM, Porrata LF, Elliott MA, Gertz MA (2004) Superior survival in primary systemic amyloidosis patients undergoing peripheral blood stem cell transplantation: a case-control study. Blood 103(10):3960–3963. https://doi.org/10.1182/blood-2003-12-4192. (Epub 2004 Jan 22 PMID: 14739213)

    Article  CAS  PubMed  Google Scholar 

  24. Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, Anderson JJ, O’Hara C, Finn KT, Libbey CA, Wiesman J, Quillen K, Swan N, Wright DG (2004) High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study. Ann Intern Med 140(2):85–93. https://doi.org/10.7326/0003-4819-140-2-200401200-00008. (PMID: 14734330)

    Article  CAS  PubMed  Google Scholar 

  25. Macedo AVS, Schwartzmann PV, de Gusmão BM, Melo MDT, Coelho-Filho OR (2020) Advances in the treatment of cardiac amyloidosis. Curr Treat Options Oncol 21(5):36. https://doi.org/10.1007/s11864-020-00738-8. (Published 2020 Apr 23)

  26. Bradshaw SH, Veinot JP (2012) Cardiac amyloidosis. Curr Opin Cardiol, 1

  27. Wittich CM, Neben-Wittich MA, Mueller PS, Gertz MA, Edwards WD (2007) Deposition of amyloid proteins in the epicardial coronary arteries of 58 patients with primary systemic amyloidosis. Cardiovasc Pathol 16(2):75–8. https://doi.org/10.1016/j.carpath.2006.09.011. (PMID: 17317539)

  28. Alloni A, Pellegrini C, Ragni T, Goggi C, D’Armini AM, Rinaldi M, Viganò M (2004) Heart transplantation in patients with amyloidosis: single-center experience. Transplant Proc 36(3):643–644. https://doi.org/10.1016/j.transproceed.2004.03.077. (PMID: 15110619)

    Article  CAS  PubMed  Google Scholar 

  29. Barrett CD, Alexander KM, Zhao H, Haddad F, Cheng P, Liao R, Wheeler MT, Liedtke M, Schrier S, Arai S, Weisshaar D, Witteles RM (2020) Outcomes in patients with cardiac amyloidosis undergoing heart transplantation. JACC Heart Fail 8(6):461–468. https://doi.org/10.1016/j.jchf.2019.12.013. (Epub 2020 May 6 PMID: 32387068)

    Article  PubMed  Google Scholar 

  30. Chen Q, Moriguchi J, Levine R, Chan J, Dimbil S, Patel J, Kittleson M, Megna D, Emerson D, Ramzy D, Trento A, Chikwe J, Kobashigawa J, Esmailian F (2021) Outcomes of heart transplantation in cardiac amyloidosis patients: a single center experience. Transplant Proc 53(1):329–334. https://doi.org/10.1016/j.transproceed.2020.08.020. (Epub 2020 Sep 8. PMID: 32917391)

  31. Di Nora C, Sponga S, Ferrara V, Patriarca F, Fanin R, Nalli C, Lechiancole A, Vendramin I, Livi U (2021) Emerging therapy in light-chain and acquired transthyretin-related amyloidosis: an Italian single-centre experience in heart transplantation. J Cardiovasc Med (Hagerstown) 22(4):261–267. https://doi.org/10.2459/JCM.0000000000001094. (PMID: 33633041)

    Article  CAS  Google Scholar 

  32. Gray Gilstrap L, Niehaus E, Malhotra R, Ton VK, Watts J, Seldin DC, Madsen JC, Semigran MJ (2014) Predictors of survival to orthotopic heart transplant in patients with light chain amyloidosis. J Heart Lung Transplant 33(2):149–56. https://doi.org/10.1016/j.healun.2013.09.004. (Epub 2013 Nov 5. PMID: 24200511; PMCID: PMC3946702)

  33. Griffin JM, Chiu L, Axsom KM, Bijou R, Clerkin KJ, Colombo P, Cuomo MO, De Los Santos J, Fried JA, Goldsmith J, Habal M, Haythe J, Helmke S, Horn EM, Latif F, Hi Lee S, Lin EF, Naka Y, Raikhelkar J, Restaino S, Sayer GT, Takayama H, Takeda K, Teruya S, Topkara V, Tsai EJ, Uriel N, Yuzefpolskaya M, Farr MA, Maurer MS (2020) United network for organ sharing outcomes after heart transplantation for al compared to ATTR cardiac amyloidosis. Clin Transplant 34(10):e14028. https://doi.org/10.1111/ctr.14028. (Epub 2020 Jul 24. Erratum in: Clin Transplant. 2021 Jun;35(6):e14325. PMID: 32623785; PMCID: PMC7744118)

  34. Grogan M, Gertz M, McCurdy A, Roeker L, Kyle R, Kushwaha S, Daly R, Dearani J, Rodeheffer R, Frantz R, Lacy M, Hayman S, McGregor C, Edwards B, Dispenzieri A (2016) Long term outcomes of cardiac transplant for immunoglobulin light chain amyloidosis: the Mayo Clinic experience. World J Transplant 6(2):380–388. https://doi.org/10.5500/wjt.v6.i2.380.PMID:27358783;PMCID:PMC4919742

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kpodonu J, Massad MG, Caines A, Geha AS (2005) Outcome of heart transplantation in patients with amyloid cardiomyopathy. J Heart Lung Transplant 24(11):1763–1765. https://doi.org/10.1016/j.healun.2004.08.025. (PMID: 16297778)

    Article  PubMed  Google Scholar 

  36. Kristen AV, Kreusser MM, Blum P, Schönland SO, Frankenstein L, Dösch AO, Knop B, Helmschrott M, Schmack B, Ruhparwar A, Hegenbart U, Katus HA, Raake PWJ (2018) Improved outcomes after heart transplantation for cardiac amyloidosis in the modern era. J Heart Lung Transplant 37(5):611–618. https://doi.org/10.1016/j.healun.2017.11.015. (Epub 2017 Nov 15 PMID: 29217108)

    Article  PubMed  Google Scholar 

  37. Kristen AV, Sack FU, Schonland SO, Hegenbart U, Helmke BM, Koch A, Schnabel PA, Röcken C, Hardt S, Remppis A, Goldschmidt H, Karck M, Ho AD, Katus HA, Dengler TJ (2009) Staged heart transplantation and chemotherapy as a treatment option in patients with severe cardiac light-chain amyloidosis. Eur J Heart Fail 11(10):1014–1020. https://doi.org/10.1093/eurjhf/hfp121. (PMID: 19789405)

    Article  CAS  PubMed  Google Scholar 

  38. Luo JM, Chou NK, Chi NH, Chen YS, Yu HY, Wang CH, Ko WJ, Tsao CI, Sun CD, Wang SS (2010) Heart transplantation in patients with amyloidosis. Transplant Proc 42(3):927–929. https://doi.org/10.1016/j.transproceed.2010.02.047. (PMID: 20430206)

    Article  PubMed  Google Scholar 

  39. McGoldrick MT, Etchill EW, Giuliano K, Barbur I, Yenokyan G, Whitman G, Kilic A (2021) Improving contemporary outcomes following heart transplantation for cardiac amyloidosis. J Card Surg 36(10):3509–3518. https://doi.org/10.1111/jocs.15796. (Epub 2021 Jul 12 PMID: 34254364)

    Article  PubMed  Google Scholar 

  40. Mignot A, Varnous S, Redonnet M, Jaccard A, Epailly E, Vermes E, Boissonnat P, Gandjbakhch I, Herpin D, Touchard G, Bridoux F (2008) Heart transplantation in systemic (AL) amyloidosis: a retrospective study of eight French patients. Arch Cardiovasc Dis 101(9):523–532. https://doi.org/10.1016/j.acvd.2008.06.018. (Epub 2008 Nov 17 PMID: 19041836)

    Article  PubMed  Google Scholar 

  41. Roig E, Almenar L, González-Vílchez F, Rábago G, Delgado J, Gómez-Bueno M, Crespo-Leiro MG, Arizón JM, de la Fuente L, Manito N (2009) Spanish Register for Heart Trasplantation. Outcomes of heart transplantation for cardiac amyloidosis: subanalysis of the spanish registry for heart transplantation. Am J Transplant 9(6):1414–9. https://doi.org/10.1111/j.1600-6143.2009.02643.x. (Epub 2009 May 13. PMID: 19459811)

  42. Rosenbaum AN, AbouEzzeddine OF, Grogan M, Dispenzieri A, Kushwaha S, Clavell A, Daly RC, Edwards BS (2018) Outcomes after cardiac transplant for wild type transthyretin amyloidosis. Transplantation 102(11):1909–1913. https://doi.org/10.1097/TP.0000000000002240. (PMID: 29677073)

  43. Vaidya GN, Patel JK, Kittleson M et al (2021) Intermediate-term outcomes of heart transplantation for cardiac amyloidosis in the current era. Clin Transplant 35(6):e14308. https://doi.org/10.1111/ctr.14308

    Article  PubMed  Google Scholar 

  44. Varr BC, Liedtke M, Arai S, Lafayette RA, Schrier SL, Witteles RM (2012) Heart transplantation and cardiac amyloidosis: approach to screening and novel management strategies. J Heart Lung Transplant 31(3):325–331. https://doi.org/10.1016/j.healun.2011.09.010

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, 82-68 164th St. Queens, New York, NY, 11432, USA

    Sofia Lakhdar & Mahmood Nassar

  2. Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA

    Chandan Buttar

  3. St. Barnabas Hospital/Albert Einstein College of Medicine, New York, NY, USA

    Camelia Ciobanu

  4. Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York, NY, USA

    Rima Patel & Most Sirajum Munira

  5. Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Most Sirajum Munira

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  1. Sofia Lakhdar
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SL conceived the study. SL and CB designed the study and performed the systematic search, study selection, and data extraction. SL and MN analyzed the data. All authors contributed to the interpretation of the data, writing and editing of the manuscript.

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Correspondence to Sofia Lakhdar.

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Lakhdar, S., Buttar, C., Nassar, M. et al. Outcomes of heart transplantation in cardiac amyloidosis: an updated systematic review. Heart Fail Rev 27, 2201–2209 (2022). https://doi.org/10.1007/s10741-022-10252-8

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