Pre-transplant amiodarone use does not affect long-term heart transplant survival

Purpose: Effect of pre-transplant amiodarone use on post-heart transplant (HT) survival is not well established. We therefore sought to examine the effect of amiodarone use on post-HT survival.

Methods: We stratified adults who underwent HT between January 2000 and August 2018 in the Scientific Registry of Transplant Recipients according to pre-transplant amiodarone use and used recipient and donor characteristics to calculate propensity scores. We then used overlap propensity score weighting to construct Cox proportional hazards regression models (adjusted for Index for Mortality Prediction After Cardiac Transplantation [IMPACT] score and donor/recipient predicted heart mass [PHM] ratio) for mortality outcomes. Logistic regression was used to compare the odds of primary graft failure and drug-treated rejection.

Results: 25,394 adult HT recipients were included; median (inter-quartile range) age was 55 (46, 62) years and 75.5% were men. Compared with nonusers, amiodarone users had a significantly higher prevalence of hypertension (46.7% vs. 50.2%; p < 0.0001), left ventricular assist device (LVAD) use (24.5% vs. 31.3%; p < 0.0001), and ventilator support (2.5% vs. 3.6%; p < 0.0001), respectively. The 10-year post-HT mortality rate in the overall population was 32.0%. Amiodarone use was associated with higher post-transplant 30-day (hazard ratio (HR) 1.25, 95% confidence interval (CI) 1.11-1.41) and 1-year mortality (HR 1.13, 1.04-1.22), but similar 5-year (HR 1.01, 95% CI 0.96-1.07) and 10-year mortality (HR 1.05, 95% CI 0.98-1.13). Amiodarone use increased primary graft failure risk (odds ratio (OR) 1.30, 95% CI 1.07-1.57) but decreased drug-treated rejection (OR 0.81, 95% CI 0.70-0.93).

Conclusions: Although pre-transplant amiodarone was associated with higher short-term mortality, its use did not affect long-term survival. Whether the short-term outcomes are related to greater graft failure risk is unclear.