Heart transplantation for cardiac amyloidosis: successful one-year outcome despite recurrence of the disease.

Systemic amyloidosis has been considered a theoretical contraindication for heart transplantation because of the concern that amyloidosis is a systemic disease that could potentially recur in the allograft. To date, no patients have been reported to have undergone heart transplantation. One year ago a patient with amyloidosis had a transplantation at the Oregon Health Sciences University, Portland. Results of kidney, rectal, and bone marrow biopsies were normal; however, endomyocardial and gingival biopsies showed positive results for amyloidosis. Recurrence of amyloidosis was detected by electron microscopy 14 weeks after transplantation; however, light microscopy has not shown any amyloidosis at 1 year. No other organ involvement has been documented. The patient is New York Heart Association functional class I, with normal resting hemodynamic parameters 1 year after transplantation. Amyloid heart disease does not necessarily portend a poor early outcome.