Abstract 17935: AL Cardiac Amyloidosis is Associated With Increased Heart Transplant Waitlist Mortality That Should Be Considered When Allocating Donor Hearts
Introduction: A new United Network for Organ Sharing (UNOS) donor heart allocation scheme is being proposed. Previous studies found patients (pts) with cardiac amyloidosis (all amyloid types) do not have increased orthotopic heart transplant (OHT) waitlist mortality compared to pts listed for other cardiomyopathies. We assessed if waitlist mortality is higher in light-chain (AL) amyloid compared to transthyretin (TTR) amyloid and non-amyloid cardiomyopathies (N-ACM), as this may suggest an allocation priority for AL amyloid pts.
Methods: Using the International Consortium for Cardiac Amyloid Transplantation (ICCAT) Registry, we analyzed cardiac amyloidosis pts listed for OHT from 1997 to 2015. The Fine-Gray model was used to compare waitlist mortality between AL and TTR pts, accounting for the competing risk of transplantation. To account for the introduction of proteasome inhibitors, the analysis was repeated with the cohort restricted to pts listed in 2008 or later. AL and TTR waitlist mortality was then compared to that for N-ACM, which was obtained from the UNOS Registry (n=25,892).
Results: We reviewed 169 cardiac amyloidosis pts from the ICCAT Registry (108 AL, 61 TTR). AL patients were younger (mean age 56.0 vs 64.8 years, p<0.001). There were no statistically significant differences in waitlist status distribution at the time of listing (33% Status 1A in AL vs 23% Status 1A in TTR, p=0.17). Compared to TTR amyloid, AL amyloid was strongly associated with increased waitlist mortality in both the overall cohort (HR 7.1, p=0.001) and the cohort restricted to 2008 or later (n=123, HR 7.3, p=0.007). In addition, compared to pts listed for N-ACM, AL pts had increased waitlist mortality (HR 1.7, p=0.028) (see figure).
Conclusions: AL pts listed for OHT have increased waitlist mortality compared to those listed for TTR or N-ACM. The increased waitlist mortality for AL pts should therefore be factored into discussions on listing priority in new heart allocation policies.
Author Disclosures: L.C. Kobashigawa: None. K.C. Verkouw: None. J.D. Estep: None. M.S. Maurer: Other Research Support; Modest; Pfizer, Inc, Alnylam Pharmaceuticals. Consultant/Advisory Board; Modest; Pfizer, Inc, Alnylam Pharmaceuticals, Ionis (ISIS) Pharmaceuticals, Prothena, Inc. M. Hanna: None. J. Patel: Research Grant; Modest; Alexion Pharmaceuticals, Pfizer, Alnylam Pharmaceuticals. R.M. Witteles: None. M. Zucker: Research Grant; Modest; Alnylam Pharmaceuticals, Pfizer, Inc. T. De Marco: Research Grant; Modest; Pfizer, Inc. M.J. Semigran: Other Research Support; Modest; Alnylam, Inc. V.N. Selby: Research Grant; Modest; Pfizer, Inc, Alnylam Pharmaceuticals. Consultant/Advisory Board; Modest; Prothena, Inc.
- © 2016 by American Heart Association, Inc.