Outcomes of Heart Transplantation in Adults With Amyloidosis: UNOS Registry Analysis

Abstracts S157 prevent them from undergoing complicated procedures due to the concern for increased risk and mortality in the event of massive blood loss. Therefore, there is minimal data on Jehovah’s Witnesses undergoing LVAD placement or heart transplantation (HT). Methods: We reviewed all 18 JW patients who underwent either LVAD (n= 12) or HT (n= 6) between 2010-2014 at our institution. We developed a preoperative protocol which includes: 1) preoperative iron, B12 and/or folic acid treatment, 2) subcutaneous erythropoietin administration, attaining a hemoglobin of at least 11 g/dL and 3) discontinuation of antiplatelet agents. We did not list patients for HT with PVR > 3.5 or those that require crossmatching. 6 patients were reoperation sternotomies. We developed operative techniques, such as incorporating a Teflon “gasket” into the LVAD outflow graft to aorta anastomosis, which are designed to minimize blood loss both intra- and post-operatively. Patients were continued on vitamin supplements and erythropoietin post-operatively if deemed necessary. No blood products were given for any patient. Results: Mean age at time of operation was 54.1±12.6 years old. Mean preoperative Hgb was 12.6±1.3 g/dL. Mean nadir Hgb during cardiopulmonary bypass was 10.2±1.8 g/dL. Mean post-operative Hgb was 10.3±1.9 g/dL. Mean ICU length of stay was 10±7 days. Within the first 30 days, there were no mortalities in the HT group and one in the LVAD group. Three patients required prolonged intubation (> 48hours). Two patients developed acute renal insufficiency (serum creatinine > 2.0 mg/dl). Perioperative stroke occurred in 1 HT patient. One, two and three years survival in the entire cohort were 88.5%, 73.8%, and 59.0%, respectively. Conclusion: In our experience, by utilizing a preoperative optimization protocol and surgical techniques designed to minimize blood loss, both heart transplantation and LVAD placement can be performed safely in Jehovah’s Witnesses. 4( 09) Outcomes of Heart Transplantation in Adults With Amyloidosis: UNOS Registry Analysis E.C. DePasquale , K. Pandya, K. Lyons, L. Reardon, A. Nsair, M. Deng, A. Ardehali.  UCLA, Los Angeles, CA. Purpose: Offering heart transplant (HT) in amyloidosis is often controversial, particularly in light of limited donor availability. We sought to examine wait list and post-HT outcomes in this population in a national registry. Methods: 77952 waitlisted (WL) pts identified from UNOS (19872013), of which 47581 underwent HT at study end. Within this cohort, 384 amyloid pts were identified (230 HT, 154 WL). Exclusions include age <  18y, follow-up loss, multiorgan transplant & re-HT. WL outcomes were assessed via competing outcomes methods. Transplant survival (Kaplan-Meier) was censored at 12y & multivariate Cox proportional hazard regression analysis (adjusted for age, sex, diabetes, race, ischemic time, dialysis, life support, waiting time & HLA mismatch) were performed. Results: 384 amyloid & 47197 non-amyloid pts were identified. Predominant etiologies: Non-amyloid group included ischemic (45%) & dilated cardiomyopathy (42%). During study, 22526 pts died (43% amyloid & 52% non-amyloid). Competing outcomes and survival are shown (Figure 1A-C). Wait list outcomes at 1-y (amyloid vs non-amyloid): Death 15% vs 12%, Transplanted (58% vs 52%), Waitlisted (6% vs 28%). Crude 1, 5 & 10y post-HT survival was: amyloid (80, 56, 31%) vs non-amyloid (86, 71 & 51%) (log-rank, p <  0.001). Unadjusted HR for all-cause mortality post-HT was 1.62 (CI 1.32-1.99, p <  0.001). After adjustment, HR was 1.46 (CI 1.14-1.87, p =  0.003). Amyloid recipients were older (p < 0.001), more frequently female (p= 0.004), with less diabetes, prior cardiac surgery and less likely to be supported with a VAD (p <  0.001) [Figure 1D-E]. Conclusion: Amyloid pts have increased rates of waiting list mortality and transplant compared to non-amyloid pts. Despite increase transplant rates, survival post HT is significantly reduced. Amyloid subtypes may impact outcomes, however, are not captured by the UNOS Registry. Collection of this data may be critical to patient selection. Further study is warranted to assess the feasibility of HT in this population.



4( 10) Analysis of a Significant Increase of Heart Transplantation Rates in Slovenia I. Knezevic ,1 G. Poglajen,2 J. Ksela,1 D. Avsec,3 M. Jelenc,1 G. Zemljic,2 R. Okrajsek,2 M. Sebestjen,2 S. Frljak,2 V. Androcec,2 T. Pintar,1 B. Vrtovec.2  1Department of Cardiovascular Surgery, UMC Ljubljana, Ljubljana, Slovenia; 2Advanced Heart Failure and Transplantation Ctr, UMC Ljubljana, Ljubljana, Slovenia; 3Sloveniatransplant, Ljubljana, Slovenia. Purpose: Recently, the numbers of heart transplants in Slovenia increased significantly, the average of last five years being 10.9 transplants per million population (pmp). In 2013, 30 heart transplantations (14.3 pmp) were performed; this was ranked as the highest average in the European Union and one of the highest worldwide. Thus, we sought to analyze factors that may have contributed to the increase in heart transplantation rates. Methods: In a retrospective study, we analyzed all heart transplantations performed in Slovenia from 1990 to 2013 and stratified them according to 2 important landmarks: (1) in 2000 Slovenia became a member of Eurotransplant network; (2) in 2009, a national Advanced Heart Failure and Transplantation Program was established joining dedicated heart failure cardiologists, cardiac surgeons and nurses in a focused effort to improve management of patients with advanced heart failure. Results: After joining Eurotransplant, organ donation and procurement network improved, which led to higher numbers of available donor organs. Since 2009, there have been on average 20 patients pmp listed for heart transplantation which is significantly more than before 2009 (7.5 pmp). On average, 35% of listed patients received a transplant each year. The mortality of patients on waiting list in Slovenia is around 10%. The average age of heart transplant recipients is about 55 years and 80% are males. The major underlying diagnoses are nonischemic dilated cardiomyopathy (47%), ischemic cardiomyopathy (44%), valvular cardiomyopathy (4.6%) and congenital heart disease (2%). Around 85% of patients have HU status at the time of transplantation. The average waiting time is around one year for elective and 27 days for high urgency heart transplantation. Prior to 2009, the 30 day, 1 year and 5 year survival rates after heart transplantation were 82%, 73% and 68%, respectively. After 2009, 30 day, 1 year and 5 year survival rates increased to 95%, 90% and 80%, respectively. Conclusion: The field of heart transplantation in Slovenia has evolved significantly, primarily due to joining the Eurotransplant network and establishing a dedicated national recipient program. This resulted in increased organ donation, heart transplantation listing, a significant increase of the number of heart transplantations, and improved survival of heart transplant recipients. 4( 11) Establishing Standard Heart Allocation Protocol in Iran S.M. Mirhosseini ,1 K. Najafizadeh,2 S. Shafaghi.3  1Modarres Hospital, The University of Shahid Beheshti, Tehran, Iran, Islamic Republic of; 2The University of Shahid Beheshti, Director of Organ Transplantation Program, Ministry of Health, Tehran, Iran, Islamic Republic of; 3Organ