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A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Cardiac transplantation using extended-donor criteria organs for systemic amyloidosis complicated by heart failure
Mathew S Maurer1, Amresh Raina, Charles Hesdorffer
1Department of Medicine, Divisions of Cardiology, Columbia University Medical Center, New York, NY 10032, USA. msm10@columbia.edu
Insights
Heart transplantation combined with stem cell or liver transplantation improves survival for systemic amyloidosis patients. This approach offers a new therapeutic option with survival rates comparable to other heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Hematology
Background:
- Systemic amyloidosis with heart failure presents significant cardiovascular risks.
- Heart transplantation for amyloidosis is debated due to disease recurrence and progression concerns.
Purpose of the Study:
- To evaluate the efficacy of a combined cardiac transplantation and subsequent stem cell or liver transplantation protocol for systemic amyloidosis patients.
- To compare survival outcomes of transplanted amyloidosis patients with non-transplanted patients and those transplanted for other conditions.
Main Methods:
- Retrospective analysis of 25 systemic amyloidosis patients evaluated for heart transplant (1997-2004).
- Development of an interdisciplinary protocol involving cardiac transplantation with extended-donor criteria organs, followed by chemotherapy/stem cell transplant (AL amyloidosis) or liver transplant (ATTR amyloidosis).
Main Results:
- Twelve patients received heart transplants; they were more likely female and had lower serum creatinine than non-transplanted patients.
- One-year survival was significantly higher in transplanted amyloidosis patients (75%) versus non-transplanted (23%).
- Short-term post-transplant survival for amyloidosis patients did not differ from other heart transplant recipients.
Conclusions:
- A strategy of cardiac transplantation with extended-donor criteria organs, followed by stem cell or liver transplantation, improves survival in cardiac amyloidosis.
- This protocol offers a novel therapeutic option for cardiac amyloidosis patients, with comparable short- to intermediate-term survival to other heart transplant indications.
Background:
Systemic amyloidosis complicated by heart failure is associated with high cardiovascular morbidity and mortality. Heart transplantation for patients with systemic amyloidosis is controversial due to recurrence of disease in the transplanted organ or progression of disease in other organs.
Methods:
All patients with systemic amyloidosis and heart failure referred for heart transplant evaluation from 1997 to 2004 were included in this retrospective cohort analysis. An interdisciplinary protocol for cardiac transplantation using extended-donor criteria organs, followed in 6 months by either high-dose chemotherapy and stem cell transplantation for patients with primary (AL) or by orthotopic liver transplantation for familial (ATTR) amyloidosis, was developed. Survival of the transplanted amyloid cohort was compared to survival of those amyloid patients not transplanted and to patients transplanted for other indications.
Results:
A total of 25 patients with systemic amyloidosis and heart failure were included in the study; 12 patients received heart transplants. Amyloid heart transplant recipients were more likely female (58% vs. 8%, P=0.02) and had lower serum creatinine (1.3+/-0.5 vs. 2.0+/-0.7 mg/dL, P=0.01) than nontransplanted amyloid patients. Survival at 1-year after heart transplant evaluation was higher among transplanted patients (75% vs. 23%) compared to patients not transplanted (P=0.001). Short-term survival posttransplant did not differ between transplanted amyloid patients and contemporaneous standard and extended-donor criteria heart transplant patients (P=0.65).
Conclusions:
Cardiac transplantation for amyloid patients with extended-donor criteria organs followed by either stem cell or liver transplantation is associated with improved survival compared to patients not transplanted. Short- to intermediate-term survival is similar to patients receiving heart transplantation for other indications. This clinical management strategy provides cardiac amyloid patients a novel therapeutic option.
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