Atrial fibrillation and central nervous complications in liver transplanted hereditary transthyretin amyloidosis patients

Atrial fibrillation and central nervous complications in liver transplanted hereditary... Abstract Background Central nervous system (CNS) complications are increasingly noted in liver transplanted (LTx) hereditary transthyretin amyloid (ATTRm) amyloidosis patients; this suggests that the increased survival allows for intracranial ATTRm formation from brain synthesised mutant TTR. However, atrial fibrillation (AF), a recognised risk factor for ischemic CNS complications, is also observed after LTx. The aim of the study was to investigate the occurrence of CNS complications and AF in LTx ATTRm amyloidosis patients. Methods The medical records of all LTx ATTRm amyloidosis patients in the county of Västerbotten, Sweden were investigated for information on CNS complications, AF, anticoagulation (AC) therapy, hypertension, cardiac ischemic disease, hypertrophy, and neurological status. Results Sixty-three patients that had survived for three years or longer after LTx were included in the analysis. Twenty-five patients had developed 1 or more CNS complications at a median of 21 years after onset of disease. AF was noted in 21 patients (median time to diagnosis 24 years). Cerebrovascular events (CVE) developed in 17 (median time to event 21 years). CVEs occurred significantly more often in patients with AF (P<0.002). AC therapy significantly reduced CVEs, including bleeding in patients with AF (P=0.04). Multivariate analysis identified AF as the only remaining regressor with a significant impact on CVE (HR 3.8; 95% CI 1.1 – 9.5; P= 0.029) Conclusions AF is an important risk factor for CVE in LTx ATTRm amyloidosis patients, and AC therapy should be considered. However the increased bleeding risk with AC therapy in patients with intracranial amyloidosis should be acknowledged. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Transplantation Wolters Kluwer Health

Atrial fibrillation and central nervous complications in liver transplanted hereditary transthyretin amyloidosis patients

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc.
ISSN
0041-1337
eISSN
1534-6080
D.O.I.
10.1097/TP.0000000000001975
Publisher site
See Article on Publisher Site

Abstract

Abstract Background Central nervous system (CNS) complications are increasingly noted in liver transplanted (LTx) hereditary transthyretin amyloid (ATTRm) amyloidosis patients; this suggests that the increased survival allows for intracranial ATTRm formation from brain synthesised mutant TTR. However, atrial fibrillation (AF), a recognised risk factor for ischemic CNS complications, is also observed after LTx. The aim of the study was to investigate the occurrence of CNS complications and AF in LTx ATTRm amyloidosis patients. Methods The medical records of all LTx ATTRm amyloidosis patients in the county of Västerbotten, Sweden were investigated for information on CNS complications, AF, anticoagulation (AC) therapy, hypertension, cardiac ischemic disease, hypertrophy, and neurological status. Results Sixty-three patients that had survived for three years or longer after LTx were included in the analysis. Twenty-five patients had developed 1 or more CNS complications at a median of 21 years after onset of disease. AF was noted in 21 patients (median time to diagnosis 24 years). Cerebrovascular events (CVE) developed in 17 (median time to event 21 years). CVEs occurred significantly more often in patients with AF (P<0.002). AC therapy significantly reduced CVEs, including bleeding in patients with AF (P=0.04). Multivariate analysis identified AF as the only remaining regressor with a significant impact on CVE (HR 3.8; 95% CI 1.1 – 9.5; P= 0.029) Conclusions AF is an important risk factor for CVE in LTx ATTRm amyloidosis patients, and AC therapy should be considered. However the increased bleeding risk with AC therapy in patients with intracranial amyloidosis should be acknowledged.

Journal

TransplantationWolters Kluwer Health

Published: Nov 1, 2017

References

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