title: Amiodarone use in patients listed for heart transplant is associated with increased 1-year post-transplant mortality.
abstract: BACKGROUND
  Pre-transplant amiodarone use has been postulated as a risk factor for morbidity and mortality after orthotopic heart transplantation (OHT). We assessed pre-OHT amiodarone use and tested the hypothesis that it is associated with impaired post-OHT outcomes.
  
  
  METHODS
  We performed a retrospective cohort analysis of adult OHT recipients from the registry of the International Society for Heart and Lung Transplantation (ISHLT). All patients had been 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.
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: lauren.b.cooper@duke.edu.
authors: Lauren B
authors: LB
authors: Cooper
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors: Robert J
authors: RJ
authors: Mentz
authors: United Network for Organ Sharing, Richmond, Virginia, USA.
authors: Leah B
authors: LB
authors: Edwards
authors: United Network for Organ Sharing, Richmond, Virginia, USA.
authors: Amber R
authors: AR
authors: Wilk
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors: Joseph G
authors: JG
authors: Rogers
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors: Chetan B
authors: CB
authors: Patel
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiovascular & Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors: Carmelo A
authors: CA
authors: Milano
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors: Adrian F
authors: AF
authors: Hernandez
authors: Department of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors: Josef
authors: J
authors: Stehlik
authors: Department of Medicine, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
authors: Lars H
authors: LH
authors: Lund
mesh_terms: D000328:Adult; D000367:Age Factors; D064591:Allografts; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000139:chemically induced* / Q000401:mortality*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014850:Waiting Lists
chemical_list: D000638:Amiodarone
keywords: antiarrhythmics; graft dysfunction; heart transplant; outcomes; pre-transplant