Up-to-date review on heart transplantation and other advanced heart failure therapies in cardiac amyloidosis patients

Cardiac amyloidosis (CA) can result in a restrictive cardiomyopathy, and heart transplantation (HT) remains the gold standard treatment for patients with end-stage heart failure secondary to amyloid cardiomyopathy. Although HT was historically contraindicated due to inferior outcomes, survival following HT in patients with CA has significantly improved over recent decades; and outcomes are now similar to those of patients undergoing HT for non-amyloid indications. This improvement has been driven largely by advances in screening for appropriate patient selection and improvement in therapeutic strategies for both immunoglobulin light-chain (AL) and transthyretin (ATTR) amyloidosis. Future directions in HT for CA will hinge on continued optimization of patient selection and refining post-transplant management of extracardiac manifestations.