Long term results of heart transplantation in patients with amyloid heart disease

Objective-To determine the outcome of heart transplantation for end stage a myloid heart disease in patients treated at a single centre. Design-Records of all patients with amyloid heart disease who underwent hea rt transplantation were examined to determine survival, graft involvement b y amyloid, the course of systemic amyloid disease, and the cause of death. Patients-10 patients, mean (SD) age 54 (8) years, received transplants in t he 13 year period 1984 to 1997. Results-Two patients, both with AL amyloid (primary systemic amyloidosis), died perioperatively. Mean follow up in the remaining eight patients was 49 .9 (39.5) months (range 3-116 months). Amyloid deposits in the grafts becam e evident histologically in five patients with AL amyloid at 5, 11, 12, 28, and 30 months after transplantation, and in one patient with familial amyl oid at 60 months. Echocardiography showed no evidence of left ventricular s ystolic impairment at the time of recurrence. Seven patients died, at 3, 11 , 26, 32, 49, 85, and 116 months after transplantation; four of these death s were related to amyloidosis. Actuarial survival at one and two years was 60% and at five years, 30%. Conclusions-Heart transplantation for amyloid heart disease remains controv ersial because of the scarcity of hearts for transplantation, the systemic nature of amyloidosis, and the potential for amyloid deposition in the graf t. Postoperative mortality was high (20%), reflecting extracardiac amyloid. Heart transplantation for end stage cardiac amyloidosis is feasible but, w ithout treatment of the underlying process, it is a palliative procedure.