Heart Transplantation for Cardiac Amyloidosis: Mayo Clinic Consensus Statement

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy secondary to amyloid fibril deposition in the myocardium. The two precursor proteins that most frequently infiltrate the heart resulting in cardiac amyloidosis are immunoglobulin light chains (AL) and transthyretin (ATTR). Regardless of the type of amyloidosis, cardiac involvement portends a worse prognosis, and those patients with symptoms of advanced heart failure should be referred to a heart failure specialist for further evaluation and management. Given the lack of formalized guidelines for heart transplantation in CA, we propose recommendations for the pretransplant evaluation and posttransplant management within the context of the best current evidence in addition to expert opinion.