Amiodarone Use Prior to Cardiac Transplant Impacts Early Post-Transplant Survival

Allana, Salman; Rajput, Furqan A.; Smith, Jason W.; Lozonschi, Lucian; Liou, Jinn-Ing; Johnson, Maryl R.; Kohmoto, Takushi; Dhingra, Ravi

doi:10.1007/s10557-020-07092-9

Cited by 2 publications

(4 citation statements)

References 39 publications

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“…Another plausible explanation for the increasing ROI liver density may be due to an accumulation of a common antiarrhythmic drug in the liver, amiodarone. This iodinated compound increases liver density measured by CT 40 and has been shown to be associated with 30‐day post‐transplant mortality 41 . Due to the heterogeneity in fibrous tissue distribution within the liver and biopsy sampling error, 42 CT measured liver density may be a non‐invasive option for detecting liver abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…This iodinated compound increases liver density measured by CT 40 and has been shown to be associated with 30-day post-transplant mortality. 41 Due to the heterogeneity in fibrous tissue distribution within the liver and biopsy sampling error, 42 CT measured liver density may be a non-invasive option for detecting liver abnormalities.…”

Section: Principal Findingsmentioning

confidence: 99%

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Computed tomography measured tissue density of pectoral muscle and liver predicts outcomes in heart transplant recipients

Kuchnia

Lortie

Osterbauer

et al. 2022

JCSM Rapid Communications

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Background Computed tomography (CT)‐derived measures of tissue quality can add to frailty assessment and improve selection of candidates for heart transplant. We investigated the prognostic value of CT measures of tissue density for predicting hospital length of stay (LOS) and mortality post‐transplant. Methods All patients at a quaternary care hospital between 1999 to 2018 with preheart transplant CT scans and available data on transplant outcomes were eligible (n = 189), including a subset within the total cohort with scans 6‐month pretransplant (n = 103). Axial chest CT scans were analysed for liver and muscle density at the 12th thoracic vertebrae and aortic arch landmarks, respectively. Cox and linear regression models examined the risk of death and LOS, respectively, according to median (above or below) pectoral muscle density. Low‐density muscle (LDM) area and liver density were analysed as continuous variables. Results Out of 157 patients with readable CT scans (median age 55 years, interquartile range [50–60] 10% women), 31 died on 1‐year follow up. Patients with higher than and at median pectoral muscle density (39.5 Hounsfield Unit [HU]) had better 1‐year survival in the overall cohort (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.673, 0.989; p = 0.039), with the 6‐month cohort showing a trend (HR 0.79, 95% CI 0.603, 1.023; p = 0.074) towards improved survival. Conversely, every 5‐cm2 increase in pectoral LDM area was associated with 2.4‐day lower LOS (p = 0.045) in the overall cohort, and a 2.6‐day lower LOS in the 6‐month cohort (p = 0.05). Patients with higher ratio of normal‐density muscle to LDM had higher LOS (p < 0.01). Every 5‐HU increase in liver density at a region of interest was associated with 0.24‐day higher post‐transplant LOS in the overall cohort, and a 0.41 higher LOS in the 6‐month cohort (p ≤ 0.05). Conclusions Patients with higher preheart transplant pectoral muscle density had greater 1‐year survival. Higher pectoral LDM area was associated with decreased LOS post‐transplant and higher liver density was associated with increased LOS. These findings raise possibilities that measures of muscle density as they reflect to quality of muscle may have prognostic implications. Future studies with prospective design are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

Computed tomography measured tissue density of pectoral muscle and liver predicts outcomes in heart transplant recipients

Kuchnia

Lortie

Osterbauer

et al. 2022

JCSM Rapid Communications

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“…Recipients with pre-transplant AF had greater likelihood of experiencing pre-discharge stroke (aOR 2.13 [95% CI: 1.07-4.26], p=0.03) and pre-discharge dialysis (aOR 1.45 [95% CI: 1.05-2.00], p=0.02; Table 2). However, recipients with and without pre-transplant AF had similar likelihood of experiencing acute rejection (aOR 1.06 [0.81-1.40], p=0.67) and requirement for pacemaker (aOR 1.12 [0.67-1.88], p=0.66), as well as similar median hospital lengths of stay (15 [11-23] vs. 16 [11][12][13][14][15][16][17][18][19][20][21][22][23][24] days, p=0.30).…”

Section: Perioperative Outcomesmentioning

confidence: 99%

“…This is important as prior literature is divided on whether pre-transplant use of amiodarone worsens post-transplant outcomes, with some studies reporting that it significantly decreases post-transplant survival and others showing no difference. 10,[18][19][20][21] Importantly, literature suggests that amiodarone dose may be a significant factor in whether pre-transplant use negatively affects post-transplant outcomes. 22 However, no prior studies examining the effects of amiodarone on post-transplant outcomes have utilized dosage thresholds for amiodarone, and thus the effect of pre-transplant amiodarone at typical AF doses has not been well described.…”

Section: Impact Of Af Pharmacotherapy Selection On Post-transplant Su...mentioning

confidence: 99%

National Incidence, Outcomes, and Management Strategies for Pre- and Post-Transplant Atrial Fibrillation in Heart Transplant Recipients

Karius,

Zhou,

Ruck

et al. 2024

Preprint

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Background: Among heart transplant candidates, atrial fibrillation (AF) is a common comorbidity; however, little is known about the impact of pre-transplant AF on incidence of post-transplant AF or other transplant outcomes. Methods: Adult heart transplant recipients transplanted from 07/01/2012 to 07/01/2021 with data available in both the Scientific Registry of Transplant Recipients and Symphony Health pharmacy databases were included. Recipients were categorized by presence of pre-transplant AF using prescription fill data. Perioperative outcomes and survival out to 5 years post-transplant were compared between those with and without pre-transplant AF. Results: Of the 11,789 heart transplant recipients, 2,477 (21.0%) had pre-transplant AF. Pre-transplant AF was associated with an increased likelihood of pre-discharge stroke (aOR 2.13 [95%CI: 1.07-4.26], p=0.03) and dialysis (aOR 1.45 [1.05-2.00], p=0.02), as well as of post-transplant AF at 6 months (aOR 2.42 [1.44-1.48], p=0.001) and 1 year (aOR 2.81 [1.72-4.56], p<0.001). Pre-transplant AF was associated with increased post-transplant mortality at 30 days (aHR 2.39 [1.29-4.44], p=0.006) and 1 year (aHR 1.46 [95% CI: 1.01-2.13], p=0.04), but similar mortality at 5 years (aHR 1.23 [0.96-1.58], p=0.11). Conclusion: Heart transplant recipients with pre-transplant AF had worse short-term outcomes and increased risk of developing post-transplant AF but comparable survival at 5 years post-transplant. Our findings emphasize the importance of increased monitoring for perioperative complications and highlight the long-term safety of heart transplantation in this population.

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Amiodarone Use Prior to Cardiac Transplant Impacts Early Post-Transplant Survival

Cited by 2 publications

References 39 publications

Computed tomography measured tissue density of pectoral muscle and liver predicts outcomes in heart transplant recipients

Computed tomography measured tissue density of pectoral muscle and liver predicts outcomes in heart transplant recipients

National Incidence, Outcomes, and Management Strategies for Pre- and Post-Transplant Atrial Fibrillation in Heart Transplant Recipients

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