Does Dofetilide (a class III antiarrhythmic medication) limit liver transplantation in patients with impaired liver function?

From the Guidelines

Dofetilide does not typically limit a patient's eligibility for liver transplantation. Dofetilide is an antiarrhythmic medication primarily used to treat atrial fibrillation and atrial flutter, and it is predominantly eliminated by the kidneys rather than the liver. According to the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, dofetilide undergoes primary renal elimination, involving glomerular filtration and active tubular secretion.

Key Considerations

• The medication may need dose adjustment based on kidney function, not liver function, as its clearance is less dependent on liver function.
• Patients taking dofetilide who need a liver transplant require careful monitoring of their QT interval and electrolytes (particularly potassium and magnesium) during the perioperative period.
• A recent review on the management of cardiac diseases in liver transplant recipients emphasizes the importance of optimizing management of metabolic syndrome and its components in liver transplant recipients, but does not specifically address dofetilide use in this context 1.
• The EASL clinical practice guidelines for liver transplantation recommend an extensive work-up before inscription onto the waiting list, including electrocardiogram and transthoracic echocardiography for all liver transplant candidates, but do not provide specific guidance on dofetilide use 1.

Clinical Implications

• If a patient is on dofetilide and scheduled for liver transplantation, the transplant team should be informed about this medication, and cardiology consultation may be warranted to determine appropriate management during the transplant process.
• The primary concern with dofetilide is its potential to cause QT prolongation and life-threatening arrhythmias, which is more related to kidney function, drug interactions, and electrolyte abnormalities rather than liver function specifically.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Dofetilide and Liver Transplant

• There is no direct evidence in the provided studies that suggests dofetilide limits a liver transplant 2, 3, 4, 5, 6.
• The studies primarily focus on the use of dofetilide in patients with atrial fibrillation and atrial flutter, its efficacy, and safety profile.
• Dofetilide is a class III antiarrhythmic agent that has been shown to be effective in converting atrial fibrillation or flutter to sinus rhythm and maintaining sinus rhythm 2, 5, 6.
• The medication has a potential proarrhythmic risk, particularly torsades de pointes, and requires careful dosing and monitoring 3, 4, 6.
• The studies do not mention any specific interactions or contraindications with liver transplants, suggesting that dofetilide's use is not directly related to limiting liver transplants 2, 3, 4, 5, 6.

Key Findings

• Dofetilide is effective in converting atrial fibrillation or flutter to sinus rhythm and maintaining sinus rhythm 2, 5, 6.
• The medication has a potential proarrhythmic risk, particularly torsades de pointes 3, 4, 6.
• Dofetilide requires careful dosing and monitoring, especially in patients with impaired renal function or a prolonged QT interval 4, 5.
• There is no direct evidence to suggest that dofetilide limits a liver transplant 2, 3, 4, 5, 6.