Preoperative Amiodarone and Primary Graft Dysfunction in Heart Transplantation

Abstract

Purpose A recent study found 6-month cumulative doses of preoperative amiodarone increased severe primary graft dysfunction (PGD) in a dose-dependent manner. We aimed to further characterize the effects of a variety of cumulative preoperative amiodarone doses on severe PGD and post-transplant outcomes. Methods Adult orthotopic heart transplant (OHT) recipients from 2012 to 2018 that were documented in the electronic medical record were included in this retrospective analysis. The primary outcome was rate of severe PGD in patients receiving amiodarone up to 1 year prior to OHT compared to those not receiving amiodarone. Cumulative administration of amiodarone at 3 months, 6 months, and 1 year prior to transplant were calculated. Secondary outcomes included ICU and hospital length of stay, duration of mechanical ventilation, early graft failure, and postoperative arrhythmias, permanent pacemaker implantation, bradycardia, rejection, and mortality at 30 days. Results There were 112 patients included in the amiodarone group and 88 patients included in the non-amiodarone group. Incidence of PGD was not significantly higher in those who received amiodarone (12.5% vs. 6.8%, p=0.18), but a trend toward increased incidence of PGD was seen with increasing cumulative doses of amiodarone. Patients on amiodarone had a significantly higher rate of postoperative bradycardia, defined as the use of theophylline or terbutaline within 30 days post-transplant (13.4% vs 4.5%, p=0.03). Conclusion An almost doubled rate of PGD in patients receiving preoperative amiodarone was observed, as well as a trend toward a higher incidence of PGD with increasing dosages of amiodarone. Our observed rate of PGD was lower than expected in the amiodarone group, which led to the study being underpowered. The increased rate of post-operative bradycardia in patients on amiodarone confirms previously published data.