Prior Amiodarone Use Does Not Affect Long-Term Survival after Heart Transplant

Purpose While thought to increase short-term mortality, the effect of amiodarone use prior to heart transplant (HT) on long-term survival is not well established. We therefore sought to examine the effect of amiodarone use on long-term survival following HT after adjustment for known risk factors. Methods We included adult patients who underwent HT between 2000 and 2018 in the Scientific Registry of Transplant Recipients according to pre-transplant amiodarone use. We constructed logistic regression models using recipient and donor characteristics to calculate propensity scores. We then used overlap propensity score weighting to construct Cox proportional hazards regression models (adjusted for IMPACT score and PHM ratio) for mortality outcomes. Adjusted logistic regression compared the odds of primary graft failure and drug-treated rejection. Results 25,394 adult HT recipients were included: median (inter-quartile range) age was 55 (46, 62) years, and 25.5% were female. Amiodarone users had a significantly higher prevalence of hypertension (46.7% v. 50.2%; p Conclusion While pre-transplant amiodarone was associated with higher short-term mortality, its use did not affect long-term survival. Whether the short-term outcomes are related to greater graft failure risk is unclear.