*Purpose: We compared the outcomes after combined heart-liver transplant (CHLT) for patients with Familial Amyloidosis (FA) versus other indications (primary cardiac:congenital heart disease and idiopathic dilated cardiomyopathy; primary liver: cardiac cirrhosis and hepatitis C) in the United States.

*Methods: We performed a retrospective review of the OPTN/UNOS database for patients who had undergone CHLT from October 1987 through April 2020. Patient survival and graft survival analyses (FA versus non-FA) were done using the R package ComparisonSurv, using the cloglog-transformed survival test of difference. Continuous variables were reported as mean (± standard deviation) or median (± IQR) and categorical variables were reported as counts/percentages. A p-value < 0.05 was considered significant.

*Results: Between 1987 and 2020, 344 CHLT were performed [74 (21.5%) FA and 270 (78.4%) non-FA]. The FA patients were significantly older (58.7 vs 42.8 years, p<0.0001) and a majority were males (85% vs. 65.6%, p = 0.001). FA patients trended towards shorter waitlist times (90.5 vs. 131 days, p = 0.07). There was no significant difference in the need for pre-transplant mechanical or ionotropic support.

The 1- and 5-year patient survival for FA patients trended to be better than non-FA patients (91.6% vs 86.5%, p = 0.26 and 85.9% vs 79.5%, p = 0.27, respectively). However, this trend reversed towards inferior survival at 10-years (55.3% vs 68.6%, p = 0.16). Graft survival for both heart and liver followed similar trends at 1-, 5-, and 10-years, though not statistically significant.

*Conclusions: In USA, CHLT recipients with familial amyloidosis are older but have excellent short-term outcomes compared to recipients transplanted for other indications. More research is needed to outline the reasons for a trend towards inferior long-term survival in CHLT recipients with FA.

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