Amiodarone Use Prior to Cardiac Transplant Impacts Early Post-Transplant Survival
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ORIGINAL ARTICLE
Amiodarone Use Prior to Cardiac Transplant Impacts Early Post-Transplant Survival Salman S. Allana 1,2 & Furqan A. Rajput 3 & Jason W. Smith 4 & Lucian Lozonschi 5 & Jinn-ing Liou 6 & Maryl Johnson 1 & Takushi Kohmoto 7 & Ravi Dhingra 1 Accepted: 6 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose It remains unclear if use of amiodarone pre-cardiac transplantation impacts early post-transplant survival. Methods We selected all patients undergoing heart transplant from 2004 to 2006 with available information using the United Network for Organ Sharing database (n = 4057). Multivariable Cox models compared the risk of death within 30 days posttransplant in patients who were taking amiodarone at the time of transplant listing (n = 1227) to those who were not (n = 2830). Results Mean age was 52 (± 12) years, and 23% were women. Patients who died within 30 days (n = 168) were older; had higher panel reactive antibody levels, higher bilirubin levels, and higher prevalence of prior cardiac surgery; were often at status 1B; and had higher use of amiodarone at listing compared to those who survived (5.3% versus 3.6%; p = 0.02). Cause of death was unknown in 49% and was reported as graft failure in 43% of cases. In multivariable Cox models, patients on amiodarone at the time of listing had 1.56-fold higher risk of post-transplant death within 30 days (95% confidence intervals 1.08–2.27) compared to patients who were not on amiodarone at listing (C-statistic 0.70). Conclusion In conclusion, patients who reported taking amiodarone at the time of listing for transplant had a higher risk of death within 30 days post-transplant. Keywords Heart transplantation . Risk . Amiodarone
Introduction
* Ravi Dhingra [email protected] 1
Department of Medicine, Cardiovascular Division, School of Medicine & Public Health, University of Wisconsin-Madison, 600 Highland Avenue, E5/582; MC 5710, Madison, WI 53792, USA
2
Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
3
Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
4
Cardiothoracic Surgery, University of Wisconsin-Madison, Madison, WI, USA
5
Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
6
Department of Epidemiology and Biostatistics, University of Wisconsin-Madison, Madison, WI, USA
7
Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
To date, heart transplantation remains the best definitive therapy for eligible end-stage heart failure patients [1]. Although the number of reported heart transplants performed in North America had relatively remained stable over the last 3 decades [2], there has been a steady increase in numbers over the past 5 years [3]. Among other reasons, increased donor availability, particularly donors from overdose deaths related to opioid epidemic in the USA have led to this recent increase [4, 5]. Despite this, the number of patients listed for heart transplant continues t
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