9–9.9 months) post-OHT, with 100% survival at 1 year and no evidence of amyloid deposition in the cardiac allograft.28 The group from the Massachusetts General Hospital in Boston reported their experience with 8 patients with cardiac amyloidosis who received sequential OHT and ASCT, with a median time of 7 months before ASCT initiation.18 At a median follow-up of

4.6 years from cardiac transplant, 62.5% (5 of the 8 patients) were alive and well with no signs of recurrent amyloidosis.18 The overall reported experience Inhibitors,research,lifescience,medical with sequential OHT and ASCT for patient with AL amyloidosis, with the noted improvement in long-term survival comparable to patients who receive heart transplants for nonamyloid Inhibitors,research,lifescience,medical heart disease, has created enthusiasm at transplant centers like ours. The Methodist Hospital Experience with End-Stage Cardiac Amyloidosis Screening Process for Heart Transplantation In addition

to our routine cardiac transplantation evaluation studies, patients at The Methodist Hospital undergo testing by physician-amyloid experts to assess the extent and severity of amyloidosis. Our Amyloid Working Group includes members from the departments of cardiology, hematology, nephrology, gastroenterology, and thoracic surgery. All patients have the diagnosis of AL Inhibitors,research,lifescience,medical amyloidosis established based on serum and urine electrophoresis with immunofixation studies, measurement of serum-free light-chain concentrations, Inhibitors,research,lifescience,medical and bone marrow biopsies. Cardiac amyloidosis is confirmed as mentioned above with focus on the severity of heart failure established by right-heart catheterization. All patients undergo coronary angiography to exclude epicardial occlusive disease. In addition, upper and lower gastrointestinal (GI) endoscopies with biopsies Inhibitors,research,lifescience,medical are obtained to screen

for GI extent of disease. Also, a liver biopsy is performed on those patients with suspected liver involvement based on abnormal liver function tests (transaminases >2x upper limits of normal) or with ascites out of proportion to right-sided hemodynamics. Patients with concomitant renal dysfunction (defined as a glomerular selleckchem filtration rate <40 cc/kg/min) and/or significant proteinuria (>1 g/day) receive a kidney biopsy. Exclusion criteria for heart or heart-multi-organ transplant consideration include the following: significant GI involvement (based on mucosal amyloid deposition by histology and clinical signs of diarrhea or malabsorption), patients with multiple myeloma (10% or more clonal bone marrow Etomidate plasma cells and evidence of symptomatic multiple myeloma that is stage I or greater), severe lifestyle limiting peripheral neuropathy on exam, severe coagulopathy, medication noncompliance, or lack of a social support care plan. Immediate Pre- and Post-Cardiac Transplantation Care All patients considered eligible for cardiac heart transplantation were listed as recipients with the Organ Procurement and Transplantation Network (OPTN).