PMID- 29019809
OWN - NLM
STAT- MEDLINE
DCOM- 20180913
LR  - 20181113
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 102
IP  - 2
DP  - 2018 Feb
TI  - Atrial Fibrillation and Central Nervous Complications in Liver Transplanted
      Hereditary Transthyretin Amyloidosis Patients.
PG  - e59-e66
LID - 10.1097/TP.0000000000001975 [doi]
AB  - 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 synthesized 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 Vasterbotten, 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 3 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 (hazard ratio, 3.8; 95% confidence interval 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.
FAU - Wange, Niklas
AU  - Wange N
AD  - Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.
FAU - Anan, Intissar
AU  - Anan I
AD  - Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.
FAU - Ericzon, Bo-Goran
AU  - Ericzon BG
AD  - Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, 
      Sweden.
FAU - Pennlert, Johanna
AU  - Pennlert J
AD  - Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.
FAU - Pilebro, Bjorn
AU  - Pilebro B
AD  - Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.
FAU - Suhr, Ole B
AU  - Suhr OB
AD  - Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.
FAU - Wixner, Jonas
AU  - Wixner J
AD  - Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - Amyloidosis, Hereditary, Transthyretin-Related
SB  - IM
MH  - Adult
MH  - Aged
MH  - Amyloid Neuropathies, Familial/*surgery
MH  - Atrial Fibrillation/*complications/mortality
MH  - Cause of Death
MH  - Cerebrovascular Disorders/*etiology
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Liver Transplantation/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*etiology
MH  - Retrospective Studies
PMC - PMC5802266
EDAT- 2017/10/12 06:00
MHDA- 2018/09/14 06:00
CRDT- 2017/10/12 06:00
PHST- 2017/10/12 06:00 [pubmed]
PHST- 2018/09/14 06:00 [medline]
PHST- 2017/10/12 06:00 [entrez]
AID - 10.1097/TP.0000000000001975 [doi]
PST - ppublish
SO  - Transplantation. 2018 Feb;102(2):e59-e66. doi: 10.1097/TP.0000000000001975.