NEED FOR RENAL REPLACEMENT THERAPY AFTER CARDIAC TRANSPLANTATION IN PATIENTS WITH AL AMYLOIDOSIS IS ASOCIATED WITH POOR SURVIVAL

Heart transplant (HT) followed by autologous stem cell transplant (ASCT) is an appropriate treatment option for patients with heart failure (HF) due to cardiac AL amyloidosis. The severity of extra-cardiac amyloid disease is believed to predict pre and post HT survival. Cox regression analysis was used to identify predictors of post HT survival from a multinational database of seven cardiac transplant centers, which includes demographic, clinical, and hemodynamic characteristics and pre HT therapies of patients with HF due to AL cardiac amyloidosis. 56 (63%) of the 89 patients waitlisted underwent HT and 50 (89%) underwent subsequent ASCT. Overall, one- and five-year survival was 88% and 72%. Of 75 pre HT and 15 post HT clinical characteristics, only the need for post-operative renal replacement therapy (RRT) during the index transplant hospitalization identified patients with decreased survival after HT (Figure). There were no differences in pre-HT demographics, hemodynamic support, eGFR (73 ± 28 vs. 63 ± 22 ml/min/1.78m2), proteinuria (803 ± 818 vs. 904 ± 1850 mg/day), or serum free light chain (FLC) ratio (0.18 ± 0.25 vs. 0.23 ±0.28) between patients requiring RRT (18%) and those who did not (82%). Patients requiring RRT had a tendency towards more post-operative infections (40% vs. 12%, p=0.06). The need for RRT post-transplant was the only characteristic identified that predicts a poor prognosis in HF patients with AL amyloidosis undergoing HT/ASCT.