Transplanting the unexpected: a case report of a heart allograft with wild-type transthyretin cardiac amyloid
Bibliographic record
Abstract
Abstract Background Cardiac amyloidosis is increasingly recognized as a cause of heart failure. Here we present a case of a heart transplant patient that inadvertently received an allograft with wild-type transthyretin amyloidosis Case summary A 62-year-old man with severe ischaemic biventricular dysfunction underwent an orthotopic heart transplantation. Donor heart details were limited to a report of moderate left ventricular hypertrophy, presumably from chronic hypertension. Post-operatively, the patient did well, but post-transplant imaging was suspicious for an underlying infiltrative cardiomyopathy. Endomyocardial biopsy confirmed that he had inadvertently received an allograft with wild-type transthyretin amyloidosis. Over the subsequent 7 years, he was followed in the Heart Transplant Clinic and was asymptomatic for 5 years post-transplantation. He then gradually developed signs of volume overload with serial imaging showing increased ventricular hypertrophy indicating progression of the cardiac amyloidosis. Subsequently, his condition deteriorated with multiple heart failure hospitalizations, ultimately favouring palliation, and died 7.5 years post-transplantation. Post-mortem autopsy analysis showed extensive allograft amyloid deposition without evidence of rejection or vasculopathy. Discussion This is the first case report of a patient that inadvertently received an allograft with cardiac amyloidosis and provides insight into the natural history of this rare clinical scenario. Based on serial imaging and post-mortem histopathologic analysis, it was clear that there was progression of the underlying cardiac amyloidosis post-transplantation. We hypothesize that this occurred through the process of amyloid seeding. This case highlights the unique clinical and histopathologic findings of cardiac amyloidosis as well as the nuances regarding donor heart selection for transplantation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".