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Background: Despite its side effects, amiodarone remains widely used for arrhythmias in patients awaiting heart transplantation (HT). We evaluated the impact of pretransplant amiodarone use and the timing of its discontinuation on the risk of primary graft dysfunction (PGD), graft survival, and recipient outcomes. Methods: We retrospectively analyzed adults undergoing primary isolated HT from the United Network for Organ Sharing registry (October 2018-December 2024). Patients were categorized by amiodarone use on the waitlist: never used, continued until HT, or discontinued within 5 days before HT. Recipient and donor characteristics were balanced using 1:1 propensity score matching between continued and discontinued groups. Kaplan-Meier methods evaluated survival, while multivariate Cox and logistic regression models identified predictors of mortality and PGD, respectively. Results: < 0.0001). Conclusions: Discontinuing amiodarone closer to HT significantly reduces severe PGD without compromising long-term recipient or graft survival. This timing strategy may further optimize perioperative outcomes in donation after circulatory death recipients.
Kwon et al. (Tue,) studied this question.