No Increase in Infections or Readmissions in Al Amyloid Patients Who Undergo Heart Transplant.

PURPOSE: After initial efforts at heart transplantation (HT) in patients with light chain amyloidosis were fraught with poor outcomes, emerging experience with modern chemotherapy regimens has led to a major improvement in outcomes in select centers. Given the systemic nature of the disease and the added immunosuppression in the form of chemotherapy, this study sought to analyze if AL patients undergoing HT had a higher burden of readmissions and infections non-amyloid heart transplant patients.

METHODS: One-year all-cause readmissions and infections requiring admissions were analyzed retrospectively between the 2 groups.

RESULTS: A total of 253 patients underwent heart transplant in our institution from 2009 to 2017, of these, 15 patients had AL-amyloidosis with substantial cardiac involvement. There was no difference in readmissions or infections 1 year from transplant (Table 1). 2/15 patients died within 1 month from transplant due to multi-organ failure and cerebrovascular accident, respectively. All patients underwent chemotherapy pre-transplant. 9/13 patients continued chemotherapy after heart transplantation with a median duration of 7.2 months (range 1.5-42 months), 1 was transferred to another institution, 2 remained in remission. Chemotherapy included bortezomib (88.9%), lenalidomide (11.1%), and melphalan (11.1%).

CONCLUSION: Despite chemotherapy pre and post HT in most AL patients, there was not a significant difference in readmissions or infections in the first year post -HT compared to non-amyloid patients undergoing HT. This adds to the growing evidence that carefully selected patients with AL amyloid can safely undergo HT with ongoing chemotherapy.