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Di Nora et al. Vessel Plus 2022;6:46 https://dx.doi.org/10.20517/2574-1209.2021.126 Page 5 of 7

Table 2. Specific examinations needed before candidacy to HTx
Specialistic evaluation Routine lab tests/physical investigation
Renal Proteinuria; count of light chains; Bence Jones proteins; urine protein electrophoresis; kidney biopsy in the case of
suspected renal amyloidosis
Hematological Blood exams; serum protein electrophoresis; plasma cell counting; bone marrow biopsy with aspirate
Neurological Clinical investigation to confirm/exclude peripheral neuropathy
Gastrointestinal Clinical investigation; stool collection for fecal fat to rule out malabsorption; esophagogastroduodenoscopy and
colonoscopy with biopsies to rule out amyloid deposits in the gastric and intestinal mucosa

HTx: Heart transplantation.

potential relapses of the disease, including routine cardiac biopsy investigations of the donor’s heart and
effectively treating any unpleasant recurrences of amyloid infiltration in the graft.

CONCLUSIONS
Heart transplantation is an effective option in patients affected by cardiac amyloidosis, both AL and ATTR.
Due to the rarity of the diagnosis, data available about HTx are scarce but encouraging. Concerning the
typical multi-organ disorders, a multidisciplinary approach is highly suggested to choose the best candidates
and reach the best long-term results. Moreover, anticipated referral to tertiary centers may be desirable to
optimize the results at early- and long-term follow-up.

DECLARATIONS
Author’s Contributions
Conceiving the manuscript and writing: Di Nora C
Contribution and implementation of the design of the research: Sponga S
Collection of the data, analyzing the data: Nalli C
Collection of the data, analyzing the data: Driussi M
Performing heart surgeries: Vendramin I
Collection of the data, performing heart surgeries: Benedetti G
Collection of the data, performing heart surgeries: Guzzi G
Planning and supervision of the manuscript: Imazio M
Planning and supervision of the manuscript: Livi U

Availability of Data and Materials
Not applicable.

Financial Support and Sponsorship
None.

Conflicts of Interest
All authors declared that there are no conflicts of interest.

Ethical Approval and Consent to Participate
Not applicable.

Consent for Publication
Not applicable.