Heart transplant

Incidence of chronic post-cardiac transplant thyroiditis and its association with the use of amiodarone before transplantation

This article was originally published here

Proc. transplant October 30, 2021: S0041-1345 (21) 00694-1. doi: 10.1016 / j.transproceed.2021.09.014. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic thyroiditis (CT) is a common cause of thyroid dysfunction and therefore could negatively affect outcome in patients undergoing heart transplantation (HT). The incidence of post-HT MDD and whether amiodarone, an antiarrhythmic drug commonly used in patients with heart failure during the pre-HT period, is associated with the development of post-HT MDD are unknown.

METHODS: A retrospective review of HT beneficiaries from February 2, 2010 to October 16, 2018 was carried out. Patients who did not have relevant pre- / post-HT records, underwent thyroidectomy, had pre-HT thyroid dysfunction or thyroiditis within 15 days post-HT, and those on amiodarone during the post-HT period. -HT were excluded, giving a final cohort of 75 patients.

RESULTS: The patients had a mean age of 63.3 ± 1.4 years and were predominantly male (90.7%) and Caucasian (80%). The incidence of post-HT CT was 32%, with the majority (83.3%) presenting with hypothyroidism. The median time to diagnosis of CT after transplantation was 10.2 months (interquartile range, 4-27.4). In addition, the CT group had a higher pre-HT use of amiodarone (non CT vs CT: 21.6% vs 50%, P = 0.01), a higher prevalence of atrial fibrillation (non CT vs CT : 23.5% vs. 45.8%; P = 0.05) and more stage IV / V chronic renal failure (non-MDD vs. MDD: 2% vs. 16.7%, P = 0.02) . In multivariate analysis, the use of pre-HT amiodarone was associated with the development of post-HT MDD after adjusting for age, sex, and chronic renal failure (odds ratio, 3.65; CI at 95%, 1.17-11.44; P = 0.03).

Conclusion: The incidence of post-HT CT is high and is strongly associated with the use of pre-HT amiodarone, which underscores the importance of closely monitoring the post-HT thyroid profile in these patients.

PMID:34728077 | DO I:10.1016 / j.transproceed.2021.09.014


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