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Heart Transplantation for Amyloid Cardiomyopathy Has Comparable Outcomes With Other Etiologies: The UNOS Database
Nicholas Steudel1,2, Ilias P Doulamis1, Shivam Rastogi1,2
1Department of Surgery, Lahey Clinic, Burlington, Massachusetts, USA.
Insights
Heart transplantation for amyloid cardiomyopathy (ACM) is increasing, with outcomes similar to other etiologies. Carefully selected ACM patients benefit from this procedure, showing comparable survival rates and lower stroke incidence.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiomyopathy Research
Background:
- Amyloid cardiomyopathy (ACM) is a progressive condition affecting the heart.
- Heart transplantation is a potential treatment for end-stage heart failure due to ACM.
- Outcomes for ACM patients undergoing heart transplantation require updated nationwide data.
Purpose of the Study:
- To compare heart transplant outcomes in ACM versus other cardiomyopathy etiologies.
- To provide updated nationwide data on ACM heart transplantation.
- To identify risk factors for mortality in ACM heart transplant recipients.
Main Methods:
- Utilized United Network for Organ Sharing data (2001-2022).
- Included adult heart transplant recipients for ACM and other cardiomyopathies (DCM, ICM, RCM, CHD).
- Employed propensity score-matched analysis to compare outcomes and mortality.
Main Results:
- Heart transplants for ACM increased 100% from 2010-2020.
- Unadjusted mortality was similar across ACM and other cardiomyopathy groups.
- ACM patients had lower postoperative stroke incidence; mechanical ventilation and older donor age were mortality risk factors.
Conclusions:
- Heart transplantation for ACM is rising, with outcomes comparable to other cardiomyopathies.
- Carefully selected ACM patients can achieve good results post-transplant.
- Further research into eligibility and adjunctive therapies may optimize ACM treatment.
Background And Aim:
This study aimed to provide updated nationwide data on outcomes in heart transplantation for amyloid cardiomyopathy (ACM) compared with other cardiomyopathy etiologies.
Methods:
United Network for Organ Sharing data for patients over 18 who underwent heart transplant for ACM, and other cardiomyopathies including DCM, ICM, RCM, and CHD were reviewed from 2001 through 2022. The data were analyzed with a propensity score-matched analysis comparing ACM patients with transplant for the cardiomyopathies to measure primary outcomes, including 5-year, 10-year, and all-cause mortality accounting for differences at baseline.
Results:
Of 21 457 heart transplant recipients who met eligibility criteria, there was a 100% increase in the number of heart transplants for ACM from 2010 to 2020 (p < 0.001). The unadjusted mortality did not differ significantly among ACM, DCM, ICM, RCM, and CHD groups, and 5-year mortality was comparable between ACM and DCM patients. ACM patients had a significantly lower incidence of postoperative stroke (p = 0.044), and risk factors for ACM transplant mortality were identified as mechanical ventilation at the time of transplant (HR: 3.8, p = 0.023) and older donor age (HR: 1.1, p = 0.015).
Conclusions:
The number of heart transplants for ACM has increased in recent years, and overall outcomes in these ACM transplants have been similar compared to those for other cardiomyopathies. Despite historical concerns regarding poor prognosis and amyloid recurrence, carefully screened ACM patients can benefit from heart transplantation. Further research and optimization of ACM patient eligibility criteria alongside investigation of concurrent adjunctive therapies could optimize treatment of ACM with heart transplantation.
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