Medical Student Université de Montréal, Quebec, Canada
Background: Numerous risk factors for primary graft dysfunction (PGD) following heart transplantation have been suggested. The recipient’s medication before heart transplantation and its association with PGD is of concern. Notably, amiodarone might exert negative chronotropic and inotropic effects via calcium channel inhibition and β-receptor blockade. Therefore, we sought to investigate the association between amiodarone medication in end-stage heart failure patients before heart transplantation, the incidence of PGD, and the need for inotropic and vasoactive support.
METHODS AND RESULTS: We retrospectively analyzed all patients who underwent heart transplantation in our center between 2010 and 2024. Exclusion criteria were redo heart transplantation and multi-organ transplantation. Pre-transplant medication, patient characteristics, postoperative echocardiography, and inotropic or vasoporessive medication were collected. The PGD classification followed the ISHLT criteria and the vaso-inotropic score (VIS) at 24h was calculated. The association between preoperative amiodarone exposure and PGD was assessed by multivariable analysis after adjustment for other risk factors.
Among the 221 heart transplant recipients, 144 were included in the study. One hundred and six patients were male (75%), with a mean age of 50.6 years old [Interquartile range, (IQR), 42-60], and mostly transplanted for a dilated cardiomyopathy (46%). Seventy-two patients received amiodarone 48 hours before HT, combined with at least another antiarrhythmic for 57 patients (39%). Fifty-three patients experienced PGD (37%) (Figure 1), of which 43 had moderate or severe L-PGD. The mean VIS at ICU admission was 24.37 [IQR, 13-33], and nearly half of the patients had mild to severe right ventricle dysfunction on echocardiography (46%). Thirty-day mortality was 11%. Pre-HT medication with amiodarone in the recipient was associated with moderate to severe PGD (p=0.0005). There was no difference in VIS at ICU admission between recipients who received amiodarone vs those who did not: 26.6 [95% CI, 23.1-30.2] vs 22.0 [95% CI, 18.2-25.8]. Moderate to severe PGD was significantly associated with 30-day mortality (p < 0.0001).
Conclusion: Pre-HT medication with amiodarone is significantly associated with moderate to severe PGD but not the VIS. Further analyses focusing on the impact of cumulative doses of amiodarone and antiarrhythmic combinations in recipients will come.
