Heart transplant (HT) is an established therapy for heart failure due to amyloidosis. The utility of gastrointestinal (GI) biopsy in predicting patient outcomes and guiding HT patient selection in this setting is unclear. We assessed 122 GI biopsies (stomach=32, duodenum=42, colorectal=48) from 60 patients undergoing HT evaluation for amyloidosis (AL=54, ATTR=6) at 6 medical centers. 50 patients were waitlisted, and 26 received a HT. The amyloid deposition was scored on a semi-quantitative scale (0-3) in the mucosa, non-vascular submucosa, and vasculature. The frequency of mucosal involvement (87% v 33%, p=0.008), submucosal involvement (81% v 20%, p=0.01), and grade 3 vascular involvement (69% v 0%, p=0.002) were higher in AL than ATTR. In AL patients, compared with colon biopsies, duodenal biopsies were more frequently positive for amyloid (100% v 86%, p=0.03) and had higher vascular scores (mean 2.7 v 2.1, p=0.02), and stomach biopsies had higher submucosal scores (1.8 v 1.0, p=0.02). For AL patients, amyloid scores were compared with outcome data from the iCCAT registry. The amyloid scores did not correlate with survival to HT as a binary outcome. Amyloid in the submucosa at any site was associated with decreased waitlist survival (p=0.04). The presence of mucosal amyloid (grade 1-3) was not associated with any outcome examined. There was a trend toward decreased overall survival from time of evaluation with grade 2-3 mucosal amyloid in the duodenum (p=0.06), and a trend toward decreased post-transplant survival with grade 2-3 mucosal amyloid at any site (p=0.07). In conclusion, duodenal biopsy has greater sensitivity than colorectal biopsy for identifying AL amyloidosis, and moderate to severe duodenal mucosal amyloid deposition may predict decreased survival in AL amyloidosis patients being evaluated for HT. Future larger studies will be necessary to confirm these findings.

CITATION INFORMATION: Li Y, Verkouw K, Tabtabai S, Barrios R, Gill R, Koo J, Marboe C, Rodriguez E, Tan C, De Marco T, Estep J, Hanna M, Maurer M, Patel J, Selby V, Semigran M, Stone J. Using Gastrointestinal Biopsy to Predict Outcome in Patients Evaluated for Cardiac Transplantation for Amyloidosis: A Report from the International Consortium on Cardiac Amyloidosis Transplantation (iCCAT). Am J Transplant. 2016;16 (suppl 3).

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