Outcomes after heart transplantation for amyloid cardiomyopathy in the modern era.

We conducted a review of patients undergoing heart transplantation (HT) at our institution for amyloid cardiomyopathy (ACM) between 2008 and 2013. Complete follow-up was available for all patients. Nineteen patients with ACM underwent HT during the study period, accounting for 9.4% of all HT performed at our institution during this period. Amyloid subtype was light chain (AL) in 9 patients and transthyretin (ATTR) in 10 (2 wild-type, 7 familial, 1 unknown). Eight of nine patients with AL amyloidosis began chemotherapy prior to HT, six have resumed chemotherapy since HT, and five have undergone autologous stem cell transplantation. Most recent free light chain levels in AL patients decreased by a median of 85% from peak values. Only one patient developed recurrent graft amyloidosis, occurring at 3.5 years post-HT and asymptomatic. After a median follow-up of 380 days, 17 (89.5%) patients are alive. To our knowledge, this is the largest single-center series reported of ACM patients undergoing HT in the modern era. Our results suggest that acceptable outcomes following HT can be achieved in the short-to-intermediate term and that this is a feasible option for end-stage ACM with careful patient selection and aggressive control of amyloidogenic light chains in AL patients.

Predictive input parameters for enteric virus presence at the inlet of a potable water supply.

Kentucky river water samples were collected at the input of a potable water supply weekly, for a period of two years. Eighteen parameters were analysed and/or recorded for each weekly observation. The variables were of a physical, chemical and biological nature. Enteric virus presence was detected by cell culture analysis from approximately 200 L samples of river water. A database of 108 observations was assembled. Of these only 100 complete observations were used for the modelling analysis. Model input parameters were selected solely based on their statistical significance in forward, backward and stepwise selection procedures. Multivariate logistic regression (MLR) was used to determine the relative significance of the input parameters for predicting the presence or absence of enteric virus. The final, best-fit MLR model that used log-transformed values for enterococci, the AC/TC ratio, faecal coliforms (FC) and temperature demonstrated 82.5 and 81.4% sensitivity and specificity, respectively.