Amiodarone use in patients listed for heart transplant is associated with increased 1-year post-transplant mortality

BACKGROUND: Pre-transplant amiodarone use has been postulated as a risk factor for morbidity and heart transplant; mortality after orthotopic heart transplantation (OHT). We assessed pre-OHT amiodarone use and tested pre-transplant; the hypothesis that it is associated with impaired post-OHT outcomes. graft dysfunction; METHODS: We performed a retrospective cohort analysis of adult OHT recipients from the registry antiarrhythmics; of the International Society for Heart and Lung Transplantation (ISHLT). All patients had been outcomes transplanted between 2005 and 2013 and were stratified by pre-OHT amiodarone use. We derived propensity scores using logistic regression with amiodarone use as the dependent variable, and assessed the associations between amiodarone use and outcomes with Kaplan-Meier analysis after matching patients 1:1 based on propensity score, and with Cox regression with adjustment for propensity score. RESULTS: Of the 14,944 OHT patients in the study cohort, 32% (N = 4,752) received pre-OHT amiodarone. Amiodarone use was higher in recent years (29% in 2005 to 2007, 32% in 2008 to 2010, 35% in 2011 to 2013). Amiodarone-treated patients were older and more frequently had a history of sudden cardiac death (27% vs 13%) and pre-OHT mechanical circulatory support. Key donor characteristics and allograft ischemia times were similar between groups. In propensity-matched analyses, amiodarone-treated patients had higher rates of cardiac reoperation (15% vs 13%) and permanent pacemaker (5% vs 3%) after OHT and before discharge. Amiodarone-treated patients also had higher 1-year mortality (hazard ratio 1.15, 95% confidence interval 1.02 to 1.30), but the risks of early graft failure, retransplantation and rehospitalization were similar between groups. CONCLUSIONS: Amiodarone use before OHT was independently associated with increased 1-year mortality. The need for amiodarone therapy should be carefully and continuously assessed in patients awaiting OHT. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.