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Published on: June 23, 2014
Successful Heart and Kidney Transplant in End-Stage Wild-Type TTR Amyloidosis and Renal Failure
Radhika K Neicheril1, Daniel Chacon2, David Snipelisky1
1Department of Cardiovascular Disease, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Florida, Weston, Florida, USA.
Background:
End-stage heart failure secondary to transthyretin cardiac amyloidosis (ATTR-CM) has a poor prognosis, particularly when complicated by multiorgan involvement such as renal failure. Combined heart and kidney transplantation remains a viable therapeutic option in carefully selected patients.
Case Summary:
A 73-year-old man recently diagnosed with ATTR-CM via technetium-99m pyrophosphate scintigraphy presented in multiorgan shock. The patient required inotropic and temporary mechanical circulatory support. Given the severity of cardiac and renal dysfunction, he underwent combined orthotopic heart and kidney transplantation. Postoperative recovery was uneventful, with continued improvement noted at 6-week follow-up.
Discussion:
This case highlights the importance of timely consideration of advanced therapies in patients with advanced ATTR-CM and multiorgan failure, particularly when traditional medical therapy is no longer viable.
Take-Home Message:
In selected patients with end-stage ATTR-CM and secondary organ failure, multiorgan transplantation can be a lifesaving therapeutic option.
