Heart Transplantation for Amyloid Cardiomyopathy Has Comparable Outcomes With Other Etiologies: The UNOS Database

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-10-09 DOI:10.1111/ctr.70343

Nicholas Steudel, Ilias P. Doulamis, Shivam Rastogi, Aspasia Tzani, Toshiki Kuno, Rabea Asleh, Hilmi Alnsasra, Nikolaos Tepetes, Ahmet Kilic, Dimitrios Avgerinos, Alexandros Briasoulis

{"title":"Heart Transplantation for Amyloid Cardiomyopathy Has Comparable Outcomes With Other Etiologies: The UNOS Database","authors":"Nicholas Steudel, Ilias P. Doulamis, Shivam Rastogi, Aspasia Tzani, Toshiki Kuno, Rabea Asleh, Hilmi Alnsasra, Nikolaos Tepetes, Ahmet Kilic, Dimitrios Avgerinos, Alexandros Briasoulis","doi":"10.1111/ctr.70343","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Aim</h3>\n \n <p>This study aimed to provide updated nationwide data on outcomes in heart transplantation for amyloid cardiomyopathy (ACM) compared with other cardiomyopathy etiologies.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>United Network for Organ Sharing data for patients over 18 who underwent heart transplant for ACM, and other cardiomyopathies including DCM, ICM, RCM, and CHD were reviewed from 2001 through 2022. The data were analyzed with a propensity score-matched analysis comparing ACM patients with transplant for the cardiomyopathies to measure primary outcomes, including 5-year, 10-year, and all-cause mortality accounting for differences at baseline.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 21 457 heart transplant recipients who met eligibility criteria, there was a 100% increase in the number of heart transplants for ACM from 2010 to 2020 (<i>p</i> < 0.001). The unadjusted mortality did not differ significantly among ACM, DCM, ICM, RCM, and CHD groups, and 5-year mortality was comparable between ACM and DCM patients. ACM patients had a significantly lower incidence of postoperative stroke (<i>p</i> = 0.044), and risk factors for ACM transplant mortality were identified as mechanical ventilation at the time of transplant (HR: 3.8, <i>p</i> = 0.023) and older donor age (HR: 1.1, <i>p</i> = 0.015).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The number of heart transplants for ACM has increased in recent years, and overall outcomes in these ACM transplants have been similar compared to those for other cardiomyopathies. Despite historical concerns regarding poor prognosis and amyloid recurrence, carefully screened ACM patients can benefit from heart transplantation. Further research and optimization of ACM patient eligibility criteria alongside investigation of concurrent adjunctive therapies could optimize treatment of ACM with heart transplantation.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70343","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aim

This study aimed to provide updated nationwide data on outcomes in heart transplantation for amyloid cardiomyopathy (ACM) compared with other cardiomyopathy etiologies.

Methods

United Network for Organ Sharing data for patients over 18 who underwent heart transplant for ACM, and other cardiomyopathies including DCM, ICM, RCM, and CHD were reviewed from 2001 through 2022. The data were analyzed with a propensity score-matched analysis comparing ACM patients with transplant for the cardiomyopathies to measure primary outcomes, including 5-year, 10-year, and all-cause mortality accounting for differences at baseline.

Results

Of 21 457 heart transplant recipients who met eligibility criteria, there was a 100% increase in the number of heart transplants for ACM from 2010 to 2020 (p < 0.001). The unadjusted mortality did not differ significantly among ACM, DCM, ICM, RCM, and CHD groups, and 5-year mortality was comparable between ACM and DCM patients. ACM patients had a significantly lower incidence of postoperative stroke (p = 0.044), and risk factors for ACM transplant mortality were identified as mechanical ventilation at the time of transplant (HR: 3.8, p = 0.023) and older donor age (HR: 1.1, p = 0.015).

Conclusions

The number of heart transplants for ACM has increased in recent years, and overall outcomes in these ACM transplants have been similar compared to those for other cardiomyopathies. Despite historical concerns regarding poor prognosis and amyloid recurrence, carefully screened ACM patients can benefit from heart transplantation. Further research and optimization of ACM patient eligibility criteria alongside investigation of concurrent adjunctive therapies could optimize treatment of ACM with heart transplantation.

Abstract Image

查看原文本刊更多论文

淀粉样蛋白心肌病的心脏移植与其他病因的结果相当：UNOS数据库。

背景和目的：本研究旨在提供最新的全国范围内淀粉样蛋白心肌病（ACM）与其他病因心肌病心脏移植结果的数据。方法：回顾了2001年至2022年18岁以上因ACM和其他心肌病（包括DCM、ICM、RCM和CHD）接受心脏移植的患者的器官共享联合网络数据。对数据进行倾向评分匹配分析，比较因心肌病而接受移植的ACM患者，以衡量主要结局，包括5年、10年和全因死亡率在基线时的差异。结果：在符合资格标准的21457名心脏移植受者中，从2010年到2020年，ACM心脏移植数量增加了100% （p < 0.001）。ACM、DCM、ICM、RCM和CHD组的未调整死亡率无显著差异，ACM和DCM患者的5年死亡率具有可比性。ACM患者术后卒中发生率明显降低（p = 0.044）， ACM移植死亡的危险因素为移植时机械通气（HR: 3.8, p = 0.023）和供体年龄较大（HR: 1.1, p = 0.015）。结论：近年来，ACM的心脏移植数量有所增加，这些ACM移植的总体结果与其他心肌病的移植结果相似。尽管历史上对预后不良和淀粉样蛋白复发的担忧，但仔细筛选的ACM患者可以从心脏移植中获益。进一步研究和优化ACM患者的资格标准以及并发辅助治疗的研究可以优化ACM的心脏移植治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.