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Outcomes in Patients With Cardiac Amyloidosis Undergoing Heart Transplantation
Christopher D Barrett1, Kevin M Alexander2, Hongyu Zhao3
1Division of Cardiology, University of Colorado Denver, Denver, Colorado.
Insights
Heart transplantation in cardiac amyloidosis patients shows similar survival rates to other heart failure patients. Careful selection ensures effective outcomes for this complex condition.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiomyopathy Research
Background:
- Cardiac amyloidosis is a progressive disease causing heart failure and mortality.
- Historically, heart transplantation outcomes were poorer for amyloidosis due to its systemic nature.
- Contemporary therapies and patient selection may improve outcomes for cardiac amyloidosis patients undergoing transplantation.
Purpose of the Study:
- To evaluate heart transplantation outcomes in patients with cardiac amyloidosis.
- To compare these outcomes with the general heart transplantation population at a single center.
Main Methods:
- Retrospective analysis of 31 cardiac amyloidosis patients undergoing heart transplantation (2004-2017).
- Comparison of pre-transplantation characteristics and post-transplantation outcomes.
- Stratification by amyloidosis type: light chain amyloidosis and transthyretin amyloidosis (ATTR).
Main Results:
- ATTR amyloidosis patients were older, more male, with worse renal function and longer wait times.
- No significant differences in post-operative complications (bleeding, renal failure, infection, rejection, malignancy) were observed.
- Mortality rates were comparable between cardiac amyloidosis patients and those transplanted for other heart failure causes.
Conclusions:
- Heart transplantation is a viable therapeutic option for carefully selected cardiac amyloidosis patients.
- Outcomes after heart transplantation for cardiac amyloidosis are similar to those for other etiologies of heart failure.
Objectives:
The purpose of this study is to report outcomes after heart transplantation in patients with cardiac amyloidosis based on a large single-center experience.
Background:
Cardiac amyloidosis causes significant morbidity and mortality, often leading to restrictive cardiomyopathy, progressive heart failure, and death. Historically, heart transplantation outcomes have been worse in patients with cardiac amyloidosis compared with other heart failure populations, in part due to the systemic nature of the disease. However, several case series have suggested that transplantation outcomes may be better in the contemporary era, likely in part due to the availability of more effective light chain suppressive therapies for light chain amyloidosis.
Methods:
This study examined all patients seen between 2004 and 2017, either at the Stanford University Medical Center or the Kaiser Permanente Santa Clara Medical Center, who were diagnosed with cardiac amyloidosis and ultimately underwent heart transplantation. This study examined pre-transplantation characteristics and post-transplantation outcomes in this group compared with the overall transplantation population at our center.
Results:
During the study period, 31 patients (13 with light chain amyloidosis and 18 with transthyretin [ATTR] amyloidosis) underwent heart transplantation. Patients with ATTR amyloidosis were older, were more likely to be male, had worse baseline renal function, and had longer waitlist times compared with both patients with light chain amyloidosis and the overall transplantation population. Post-transplantation, there were no differences in post-operative bleeding, renal failure, infection, rejection, or malignancy. There was no significant difference in mortality between patients who underwent heart transplantation for amyloid cardiomyopathy and patients who underwent heart transplantation for all other indications.
Conclusions:
In carefully selected patients with cardiac amyloidosis, heart transplantation can be an effective therapeutic option with outcomes similar to those transplanted for other causes of heart failure.
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