**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Natasha Gorrie, St Vincent's Hospital Sydney, Sydney, NSW

**Main Body of the Abstract**
Background:Abnormal protein fibril deposition in amyloid cardiomyopathy(CM) results in restrictive physiology, typically presenting as heart failure(HF). This is most commonly due transthyretin(ATTR) deposition, from pathogenic genetic variants(ATTRv) or abnormal protein folding(ATTRwt). Prognosis remains poor, typically less than 4years and heart transplantation(HT) remains the only definitive advanced HF treatment. HT has been underutilised in ATTR-CM, particularly ATTRwt, due to patient factors; traditionally poor outcomes, comorbidities and age, and systemic factors; late diagnosis, under-recognition of severity and waitlist times. Waitlist changes and improving outcomes mean HT is an increasing therapeutic option. We review our ATTR-CM HT outcomes over time.
Methods:Patients with ATTR-CM who underwent HT at St Vincent’s Hospital with between January 2010-2024 were studied.
Results:Five patients with ATTR-CM underwent HT. All were diagnosed pre-transplant, male, NYHA III with a median age 66years(range 59-71). Genetic assessment identified one pathogenic variant(TTRp.Val40Ile), others were ATTRwt. Three patients were Gilmore Stage II. Mean left ventricular ejection fraction was 44% but cardiac index was very low, 1.7L/min/m2. None required mechanical bridge-to-transplantation. Four were transplanted since 2019, all were alive at 1-year and median survival was 3.63years. Three deaths, from chronic renal failure requiring haemodialysis, metastatic melanoma and COVID-19, occured respectively. ATTR-CM did not recur on routine follow-up. Autonomic neuropathy occurred post-HT in two, with no documented end organ extra-cardiac manifestations prior.
Conclusions:Although larger numbers and longer follow-up is required, HT has reasonable short-to-medium term outcomes in a small ATTR-CM cohort, especially ATTRwt. Despite historical underutilisation, HT is a growing option in the evolving ATTR-CM management landscape.



**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Natasha Gorrie, St Vincent's Hospital Sydney, Sydney, NSW

**Main Body of the Abstract**
Background:Abnormal protein fibril deposition in amyloid cardiomyopathy(CM) results in restrictive physiology, typically presenting as heart failure(HF). This is most commonly due transthyretin(ATTR) deposition, from pathogenic genetic variants(ATTRv) or abnormal protein folding(ATTRwt). Prognosis remains poor, typically less than 4years and heart transplantation(HT) remains the only definitive advanced HF treatment. HT has been underutilised in ATTR-CM, particularly ATTRwt, due to patient factors; traditionally poor outcomes, comorbidities and age, and systemic factors; late diagnosis, under-recognition of severity and waitlist times. Waitlist changes and improving outcomes mean HT is an increasing therapeutic option. We review our ATTR-CM HT outcomes over time.
Methods:Patients with ATTR-CM who underwent HT at St Vincent’s Hospital with between January 2010-2024 were studied.
Results:Five patients with ATTR-CM underwent HT. All were diagnosed pre-transplant, male, NYHA III with a median age 66years(range 59-71). Genetic assessment identified one pathogenic variant(_TTR_p.Val40Ile), others were ATTRwt. Three patients were Gilmore Stage II. Mean left ventricular ejection fraction was 44% but cardiac index was very low, 1.7L/min/m2. None required mechanical bridge-to-transplantation. Four were transplanted since 2019, all were alive at 1-year and median survival was 3.63years. Three deaths, from chronic renal failure requiring haemodialysis, metastatic melanoma and COVID-19, occured respectively. ATTR-CM did not recur on routine follow-up. Autonomic neuropathy occurred post-HT in two, with no documented end organ extra-cardiac manifestations prior.
Conclusions:Although larger numbers and longer follow-up is required, HT has reasonable short-to-medium term outcomes in a small ATTR-CM cohort, especially ATTRwt. Despite historical underutilisation, HT is a growing option in the evolving ATTR-CM management landscape.



Cardiac transplantation for transthyretin amyloidosis (ATTR): A single centre experience PB152 (#446)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.