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Updated: Jun 3, 2025
A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
Published on: February 14, 2022
Amyloidosis and Heart Transplantation in a New Era
Melissa A Lyle1, Juan Maria M Farina2, Erin Wiedmeier-Nutor3
1Department of Transplantation, Division of Advanced Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, Florida, USA.
Insights
Heart transplantation (HT) in cardiac amyloidosis (CA) patients shows survival similar to non-amyloid patients. The updated Organ Procurement and Transplantation Network (OPTN) allocation system significantly reduces wait times for these individuals.
Area of Science:
- Cardiology
- Transplantation Medicine
- Nephrology
Background:
- Prognosis for advanced cardiac amyloidosis (CA) is historically poor.
- Heart transplantation (HT) is a potential treatment for end-stage CA.
- Understanding outcomes in CA patients post-HT is crucial for treatment strategies.
Purpose of the Study:
- To compare survival rates after HT in cardiac amyloidosis versus non-amyloid patients.
- To evaluate waitlist times under the new Organ Procurement and Transplantation Network (OPTN) allocation system.
- To describe multiorgan transplantation (MOT) trends in hereditary amyloidosis.
Main Methods:
- Retrospective review of 55 end-stage CA patients undergoing HT (2007-2020).
- Comparison of wait times between new (post-Dec 2018) and old OPTN allocation systems.
- Survival analysis using Kaplan-Meier estimates and log-rank tests, censoring Dec 2022.
Main Results:
- No significant difference in overall survival post-HT between amyloid and non-amyloid recipients (p = 0.816).
- Median HT wait time was significantly shorter in the new allocation system (45 days vs. 174 days, p = 0.006).
- A decrease in multiorgan transplantation (MOT) for hereditary amyloidosis was observed, coinciding with increased use of disease-targeted therapies.
Conclusions:
- Heart transplantation offers comparable survival for cardiac amyloidosis patients versus non-amyloid patients.
- The current OPTN allocation system improves access to HT for CA patients through reduced wait times.
- Increased utilization of disease-targeted therapies correlates with decreased MOT in hereditary amyloidosis.
Background:
The prognosis in patients with advanced cardiac amyloidosis (CA) remains poor.
Objectives:
We sought to describe survival post heart transplantation (HT) in amyloid compared with non-amyloid recipients, highlight waitlist times within the new allocation system across three Organ Procurement and Transplantation Network (OPTN) regions, and describe multiorgan transplantation (MOT) in hereditary amyloidosis.
Methods:
This is a retrospective review of end-stage CA patients who underwent HT at Mayo Clinic from January 2007 to December 2020. Wait time was compared in the new versus old OPTN allocation era starting December 18, 2018 by Wilcoxon rank sum test. All-cause mortality for those with and without CA was compared using Kaplan-Meier estimates with log rank analysis, censoring December 16, 2022.
Results:
Fifty-five patients with CA underwent HT between 2007 and 2020, 8 light chain amyloidosis (AL) (14.5%), 28 hereditary transthyretin (ATTRv) (50.9%), 17 wildtype transthyretin (ATTRwt) (30.9%), and 2 hereditary apolipoprotein A1 (AApoA1) amyloidosis patients (3.6%). No significant difference in overall survival post-transplant was seen in amyloid compared with non-amyloid (p = 0.816). Median time to HT was shorter in the new system, 45 days (IQR 24, 78) versus 174 days (IQR 76.5, 483.5), p = 0.006. There was a decline in MOT in hereditary amyloidosis over time with the concomitant rise in disease-targeted therapies.
Conclusions:
HT survival in CA patients was similar to non-amyloid patients. The new allocation system benefits this cohort with shorter wait times. There is less MOT in hereditary amyloidosis with increased utilization of disease-targeted therapy.
