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

Background: 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. Methods: Retrospective analysis of the United Network of Organ Sharing registry (n = 62,709) for all patients transplanted between 1987 and 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. Multiorgan 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 analyses using Cox modeling and competing outcomes analyses were performed. Results: RCM patients were older, female, with older donors and longer ischemic times (p