Is Amiodarone Truly a Risk Factor for Primary Graft Dysfunction in Heart Transplantation

Abstract

Purpose Primary graft dysfunction (PGD) after heart transplantation (HTx) is seen in approximately 10-30% of patients immediately post-transplant. The cause of PGD is not clear but may include recipient, donor and peri-operative factors. Most recently, the presence of amiodarone at time of HTx has been associated with development of PGD. The mechanisms of this association are not clear. We sought to confirm this observation in a large single-center study. Methods Between 2010 and 2015, we assessed 364 heart transplant patients. We divided this cohort into those that were on amiodarone at the time of HTx (n=73) and those who were not on amiodarone (n=291). PGD was defined per the ISHLT PGD Grading Scale (mild, moderate, and severe PGD). Patients on amiodarone were further subdivided into those with high-dose (>200 mg daily, n=34) vs low-dose therapy (≤200 mg daily, n=37). Finally, we assessed whether pre-transplant MCS placement in patients on amiodarone affected the development of PGD. Results Patients on amiodarone at the time of HTx did not appear to have increased risk of any grade of PGD vs those not on amiodarone. The dosage of amiodarone (low dose vs high dose) also was similar for patients between groups. MCS placement did not have a significant effect on outcome. (see Table) Conclusion Amiodarone use at the time of HTx (regardless of dose) does not appear to be a risk factor for the development of PGD. Larger studies are needed to confirm these findings.