Heart transplant outcomes in restrictive cardiomyopathy: UNOS registry analysis of the last three decades

Restrictive cardiomyopathy (RCM) comprises diverse etiologies with overall poor prognosis. Emerging therapies have significantly impacted some of these entities. However, these therapies may have limited impact in the end-stages and have only recently become available. We sought to assess outcomes before and after transplant in the RCM population stratified into 3 distinct time periods from the recent era. Retrospective analysis of the UNOS registry (n=62709) for all patients transplanted between 1987 - March 1, 2022 were stratified by RCM status with 1157 patients with RCM. Populations were grouped temporally into classic (1987-2000), contemporary (2000-2013), and current (2014-2022) eras. Multi-organ and repeat transplants were excluded from the analysis. Baseline demographics, listing status, hemodynamics, donor information, and life support methods were compared using Kruskal-Wallis and Pearson’s tests. Longitudinal survival was assessed via Kaplan-Meier survival analysis. Univariate and multivariate analysis using Cox modeling and competing outcomes analyses were performed. RCM patients were older, female, with older donors and longer ischemic times (p<0.001). There were no significant differences in overall survival compared to the non-RCM population, however, with increased transplant rates. Amyloidosis and chemotherapy/radiation portend the worst prognosis but have shorter waitlist times and up-trending survival in the current era. RCM represents a small but significant population of those requiring heart transplant. RCM transplant outcomes appear to be improving across all subsets with shorter wait times and better survival. Early recognition is important to help mitigate adverse outcomes.