Heart Transplantation, Either Alone or Combined With Liver and Kidney, a Viable Treatment Option for Selected Patients With Severe Cardiac Amyloidosis

Soulef Guendouz, MD; Philippe Grimbert, MD, PhD; Costin Radu, MD, PhD; Daniel Cherqui, MD, PhD; Chady Salloum, MD; Nicolas Mongardon, MD, PhD; Sami Maghrebi, MD; Karim Belhadj, MD; Fabien Le Bras, MD; Emmanuel Teiger, MD, PhD; Jean-Paul Couetil, MD, PhD; Adriana Balan, MD; Mounira Kharoubi, MSc; Mélanie Bézard, MSc; Silvia Oghina, MD; Diane Bodez, MD, PhD; Luc Hittinger, MD, PhD; Vincent Audard, MD, PhD; Violaine Planté-Bordeneuve, MD, PhD; Alexandre De la Taille, MD, PhD; Eric Bergoend, MD; Valerie Frenkel, MD, PhD; Pascale Fanen, MD, PhD; Vincent Leroy, MD, PhD; Christophe Duvoux, MD, PhD; Maryvonnick Carmagnat, PharmD; Thierry Folliguet, MD, PhD; Thibaud Damy, MD, PhD

doi:10.1097/TXD.0000000000001323

Transplantation Direct (Jul 2022)

Heart Transplantation, Either Alone or Combined With Liver and Kidney, a Viable Treatment Option for Selected Patients With Severe Cardiac Amyloidosis

Soulef Guendouz, MD,
Philippe Grimbert, MD, PhD,
Costin Radu, MD, PhD,
Daniel Cherqui, MD, PhD,
Chady Salloum, MD,
Nicolas Mongardon, MD, PhD,
Sami Maghrebi, MD,
Karim Belhadj, MD,
Fabien Le Bras, MD,
Emmanuel Teiger, MD, PhD,
Jean-Paul Couetil, MD, PhD,
Adriana Balan, MD,
Mounira Kharoubi, MSc,
Mélanie Bézard, MSc,
Silvia Oghina, MD,
Diane Bodez, MD, PhD,
Luc Hittinger, MD, PhD,
Vincent Audard, MD, PhD,
Violaine Planté-Bordeneuve, MD, PhD,
Alexandre De la Taille, MD, PhD,
Eric Bergoend, MD,
Valerie Frenkel, MD, PhD,
Pascale Fanen, MD, PhD,
Vincent Leroy, MD, PhD,
Christophe Duvoux, MD, PhD,
Maryvonnick Carmagnat, PharmD,
Thierry Folliguet, MD, PhD,
Thibaud Damy, MD, PhD

Affiliations

Soulef Guendouz, MD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Philippe Grimbert, MD, PhD: 4 APHP, Department of Nephrology and Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Henri Mondor University Hospital, Créteil, France.
Costin Radu, MD, PhD: 6 APHP, Department of Cardiac Surgery, Henri Mondor University Hospital, Creteil, France.
Daniel Cherqui, MD, PhD: 7 APHP, Hepatobiliary Center, Paul Brousse Hospital – University Paris Saclay, France.
Chady Salloum, MD: 7 APHP, Hepatobiliary Center, Paul Brousse Hospital – University Paris Saclay, France.
Nicolas Mongardon, MD, PhD: 5 University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.
Sami Maghrebi, MD: 8 APHP, Surgical Intensive Care Unit, Cardiovascular Surgery Intensive Care Unit, Henri Mondor University Hospital, Créteil, France.
Karim Belhadj, MD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Fabien Le Bras, MD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Emmanuel Teiger, MD, PhD: 2 APHP, Cardiology Department, Henri Mondor University Hospital, Créteil, France.
Jean-Paul Couetil, MD, PhD: 6 APHP, Department of Cardiac Surgery, Henri Mondor University Hospital, Creteil, France.
Adriana Balan, MD: 6 APHP, Department of Cardiac Surgery, Henri Mondor University Hospital, Creteil, France.
Mounira Kharoubi, MSc: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Mélanie Bézard, MSc: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Silvia Oghina, MD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Diane Bodez, MD, PhD: 10 Centre Cardiologique du Nord, Cardiac Outpatient Unit, Saint Denis, France.
Luc Hittinger, MD, PhD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Vincent Audard, MD, PhD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Violaine Planté-Bordeneuve, MD, PhD: 3 Amyloidosis Mondor Network, APHP, Henri Mondor University Hospital, Créteil, France.
Alexandre De la Taille, MD, PhD: 12 APHP, Department of Surgical Urology, Henri Mondor University Hospital, Créteil, France.
Eric Bergoend, MD: 6 APHP, Department of Cardiac Surgery, Henri Mondor University Hospital, Creteil, France.
Valerie Frenkel, MD, PhD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Pascale Fanen, MD, PhD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.
Vincent Leroy, MD, PhD: 15 APHP, Department of Hepatology, Henri Mondor University Hospital, Créteil, France.
Christophe Duvoux, MD, PhD: 15 APHP, Department of Hepatology, Henri Mondor University Hospital, Créteil, France.
Maryvonnick Carmagnat, PharmD: 16 APHP, Laboratory of Immunology and Histocompatibility, Saint Louis Hospital, Paris, France.
Thierry Folliguet, MD, PhD: 6 APHP, Department of Cardiac Surgery, Henri Mondor University Hospital, Creteil, France.
Thibaud Damy, MD, PhD: 1 French National Referral Centre for Cardiac Amyloidosis, Créteil, France.

DOI: https://doi.org/10.1097/TXD.0000000000001323
Journal volume & issue: Vol. 8, no. 7
p. e1323

Abstract

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Background. Heart transplantation in cardiac amyloidosis (CA) patients is possible and generally considered for transplantation if other organs are not affected. In this study, we aimed to describe and assess outcome in patients following heart transplantations at our CA referral center. Methods. We assessed all CA patients that had heart transplantations at our center between 2005 and 2018. Patients with New York Heart Association status 3 out of 4, with poor short-term prognosis due to heart failure, despite treatment, and without multiple myeloma, systemic disease, severe neuropathic/digestive comorbidities, cancer, or worsening infections were eligible for transplantation. Hearts were transplanted by bicaval technique. Standard induction and immunosuppressive therapies were used. Survival outcome of CA patients after transplantation was compared with recipients with nonamyloid pathologies in France. Results. Between 2005 and 2018, 23 CA patients had heart transplants: 17 (74%) had light chain (light chain amyloidosis [AL]) and 6 (26%) had hereditary transthyretin (hereditary transthyretin amyloidosis [ATTRv]) CA. Also, 13 (57%) were male, and the mean age at diagnosis was 56.5 y (range, 47.7–62.8). Among AL patients, 13 had heart-only and 5 had heart-kidney transplantations. Among ATTRv patients, 1 had heart-only and 5 had heart-liver transplantations. The 1-y survival rate after transplantation was 78%, 70% with AL, and 100% with ATTRv. At 2 y, 74% were alive: 65% with AL and 100% with ATTRv. Conclusion. After heart transplantation, French CA and nonamyloid patients have similar survival outcomes. Among CA patients, ATTRv patients have better prognosis than those with AL, possibly due to the combined heart-liver transplantation. Selected CA patients should be considered for heart transplantations.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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