Intermediate-term Outcomes of Heart Transplantation for Cardiac Amyloidosis in the Current Era.

BACKGROUND Cardiac amyloidosis (CA) has been historically noted with poor outcomes after heart transplant (HTx). However, strict patient selection, appropriate multi-organ transplant and aggressive post-transplant therapy can result in favorable outcomes. We present the experience in the largest single-center cohort of CA patients post-HTx in the recent era. METHODS Between Jan 2010 and Dec 2018, 51 CA patients underwent HTx - 13 light-chain amyloidosis (AL) and 38 transthyretin amyloidosis (ATTR), 49 were included. Endpoints included 3-year survival, freedom from cardiac allograft vasculopathy (CAV) and freedom from non-fatal major adverse cardiac events (NF-MACE). RESULTS Overall 3-year survival was 81.6% (69.2% for AL and 86% for ATTR) and was comparable to survival for patients transplanted for non-amyloid restrictive cardiomyopathy (RCM) in the same period (89%, p=0.46). Three-year freedom from CAV (84% vs 89%, p=0.98), NF-MACE (82% vs 83%, p=0.96), and any treated rejection (95% vs 89%, p=0.54) were also comparable in both groups. No recurrence in amyloid was noted in endomyocardial biopsies. Six patients (46%) with AL-amyloidosis underwent autologous stem cell transplant one-year post-HTx and 2 patients (8%) with variant ATTR-CA underwent combined heart-liver transplant due to cardiac cirrhosis. CONCLUSION In the current era, both AL and ATTR cardiac amyloidosis patients have acceptable outcomes after heart transplantation.