title: Amyloid fibril composition as a predictor of development of cardiomyopathy after liver transplantation for hereditary transthyretin amyloidosis.
abstract: BACKGROUND
  Liver transplantation (LTx) is an accepted treatment for hereditary transthyretin (TTR) amyloidosis (ATTR). However, unforeseen heart complications, especially a rapid development of cardiomyopathy after LTx has affected mortality and morbidity. Recently, a relationship between ATTR-fibril composition and cardiomyopathy has been noted. The aim of this study was to investigate whether development of cardiomyopathy and heart failure in LTx ATTR amyloid patients is related to amyloid fibril composition.
  
  
  METHODS
  Twenty-four patients with hereditary ATTR amyloidosis who had undergone LTx and have had their amyloid fibril type tested were available for the study. They had been examined by echocardiography including tissue Doppler and speckle tracking echocardiography before and after LTx. Patients were divided into two groups according to fibril composition, 10 patients with type A fibrils (a mixture of truncated and full-length TTR) and 14 patients with type B fibrils (full-length TTR fibrils only). There was no difference in time to the follow-up echocardiography between the two groups.
  
  
  RESULTS
  After LTx, the group consisting of type A patients developed symptoms of heart failure and with reduced systolic and diastolic ventricular function as shown by echocardiography, whereas no similar deterioration was noted for the group of patients with type B fibrils.
  
  
  CONCLUSIONS
  Patients with type A fibrils deteriorate an already existing cardiomyopathy and heart failure after LTx, in contrast to patients with type B fibrils. These results might have significant clinical implications in optimizing best patients selection criteria for LTx.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University and University Hospital, Umeå, Sweden.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gustafsson
authors.forename: Elisabet
authors.initials: E
authors.lastname: Ihse
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
authors.forename: Per
authors.initials: P
authors.lastname: Westermark
authors.forename: Per
authors.initials: P
authors.lastname: Lindqvist
authors.forename: Ole B
authors.initials: OB
authors.lastname: Suhr
mesh_terms: D000328:Adult; D000682:Amyloid / Q000032:analysis*; D028226:Amyloidosis, Familial / Q000601:surgery*; D009202:Cardiomyopathies / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011228:Prealbumin / Q000235:genetics*
chemical_list: D000682:Amyloid; D011228:Prealbumin