Long-term Survival of Lung Transplant Recipients with Early Post-operative Atrial Fibrillation Treated with Amiodarone

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Purpose: Atrial fibrillation/flutter (AF) is a common early post-operative complication after lung transplantation (LTX) and has been associated with increased morbidity and mortality. The optimal management has not been established. Some studies have suggested increased mortality with the use of amiodarone. Our standard approach is early rhythm control with amiodarone followed by cardioversion if needed. Anticoagulation is withheld if sinus rhythm is restored within 48 hours. We sought to review our experience to determine if the occurrence of AF was associated with increased morbidity and/or mortality and specifically, if survival was lower with the use of amiodarone.

Methods: Adult LTX recipients with AF occurring during the index transplant hospital stay were identified. Characteristics of these patients were compared with a contemporaneous cohort without AF. Wilcoxon Rank Sum Tests were used to compare length of stays (LOS), duration of mechanical ventilation, and age at time of transplant. Fishers Exact tests were used to evaluate acute kidney injury (AKI) and primary graft dysfunction (PGD). Post transplant survival was compared with log-rank analysis of Kaplan-Meir estimates.

Results: Between Sept 2017 – Oct 2024, 104 out of 294 (35%) LTX recipients developed post-operative AF. The AF group was slightly older (67.7 vs 64.9; p=.0002), but otherwise similar to the non-AF cohort with respect to gender, comorbidities, underlying disease and transplant type. Both ICU (median 6.5 vs 3.5 days; P< 0.001), and total hospital LOS (21 vs 16 days; P< 0.001) were longer in the AF group. The AF group had a higher incidence of acute kidney injury of any severity (46% vs 27%; P=0.002) and any grade of primary graft dysfunction (53% vs. 42%; P=0.12). Eighty (77%) patients with AF received amiodarone therapy, 16 (15%) underwent cardioversion and 15 (14%) were anticoagulated. Survival at 1, 3 and 5 yrs post-transplant was 94%, 86% and 79%, respectively, in the AF group vs. 97%, 93% and 80% in the no AF cohort (P=0.36). Among subject treated with amiodarone, survival was 92%, 83% and 74% at 1, 3 and 5 yr, respectively (P=0.19 vs. no AF).

Conclusion: Early post-transplant AF is associated with longer LOS and higher incidence of AKI, but long-term survival was comparable to recipient without AF. Amiodarone use was not associated with increased mortality. Additional studies are required to determine the optimal approach to the prevention and management of post-operative AF after LTX.

Volume

211

First Page

A1740

Last Page

A1740

Comments

American Thoracic Society International Conference, May 16-25, 2025, San Francisco, CA

DOI

10.1164/ajrccm.2025.211.Abstracts.A1740

ISSN

1535-4970

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