Peri-Operative Serum Amiodarone Levels are Not Predictive of Graft Dysfunction in Orthotopic Heart Transplantation.

Purpose Primary graft dysfunction (PGD) in orthotopic heart transplant (OHT) carries a large morbidity and mortality. We have previously reported a dose-dependent association with pre-transplant amiodarone usage and PGD in patients with OHT. We conducted a prospective study to elucidate if preoperative serum amiodarone level could predict PGD. Methods Since 2017, we began to monitor serum amiodarone and amiodarone metabolite levels in the peri-operative period prior transplantation. Degree of PGD was determined for each patient post-operatively using the ISHLT Diagnostic Criteria and Classification of PGD. The data was prospectively collected in 54 patients. The risk of PGD was calculated with linear regression. Results The median age for the cohort was 54.5 (IQR 45-65) and 77.8% were male. Baseline height and BMI were 172.7cm (IQR 167- 178) and 27.5 kg/m2 (24.6- 30.8), respectively. Forty-one patients (75.9%) were bridged to transplant. Median cardiopulmonary bypass and ischemic times were 132 (IQR 118- 154) and 163 min (IQR 120- 208), respectively. Median intraoperative inotrope score was 6.9 (3.7-12.6). Twenty-six patients (48.2%) were taking amiodarone prior to OHT with a median dose of 200 mg daily, and the median total serum amiodarone level was 1.7μg/mL (1.2-2.1). Two patients (3.7%) experienced mild PGD. One (1.9%) and eleven (20.4%) patients experienced moderate and severe PGD, respectively. The risk of developing PGD was not correlated with amiodarone level (r = 0.31, 95% CI= -1.2-1.9, p=0.68). The risk of developing severe PGD was also not correlated with amiodarone level (r = -0.05, 95% CI=-1.4-1.4, p=0.94). Conclusion No predictive association could be made between the one-time preoperative amiodarone serum level and the risk of developing PGD. [ABSTRACT FROM AUTHOR]