*Purpose: Cardiac amyloidosis is an infiltrative cardiomyopathy with poor outcomes. Cardiac transplantation and increased utilization of mechanical support have led to improved outcomes in patients with amyloidosis. In this study, we sought to investigate if the changes in the UNOS allocations system have impacted the post-transplant survival in patients with amyloidosis.

*Methods: We identified 35 patients with amyloidosis in the UNOS database who underwent heart transplant during a 6-month period immediately before and after the policy change. Our data included 24 pre and 11 post policy change patients. We used standard statistical methods to compare the patient characteristics in both groups. Survival analysis was performed using Cox proportional hazards modeling.

*Results: The recipient age, donor age, gender, ethnicity, diabetes status, and ischemic times were not significantly different between the two groups. Pre-transplant hemodynamic parameters and serum creatinine were also not significantly different between the two groups. The waitlist (WL) statuses of pre patients were 1A (n=15), 1B (n=5), 2 (n=4) while the WL statuses of the post patients were 2 (n=7), 3 (n=2), 4 (n=2). There was no significant difference in the total days on WL (26 days vs. 29 days, p= 0.82). The use of IABP was significantly greater following the policy change (55% post vs 4% pre, p<0.001). However, there was no difference in 6 month survival between the two groups.

*Conclusions: Although patients with amyloidosis on the transplant list had similar baseline characteristics pre and post changes in the UNOS organ allocation policy, more patients in the post allocation system change group were receiving IABP support. The policy changes had no significant effect on patient WL times or survival.

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