Temporal Trends and Post-Transplant Outcomes in Anthracycline-Induced Cardiomyopathy: A Contemporary United Network for Organ Sharing Analysis.

Background:Outcomes after heart transplantation for anthracycline-induced cardiomyopathy (AICM) remain incompletely characterized, particularly compared with idiopathic dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM). Methods:We analyzed adult first-time isolated heart transplant recipients in the Organ Procurement and Transplantation Network/United Network for Organ Sharing registry from January 1, 2000, to September 25, 2025. Recipients were grouped as AICM, idiopathic DCM, or ICM by registry diagnosis. The primary outcome was all-cause post-transplant mortality. Secondary outcomes included graft failure, post-transplant dialysis, stroke, pacemaker implantation, treated rejection, and length of stay. Results:Compared with idiopathic DCM, AICM was not associated with higher adjusted mortality (HR 1.11, 95% CI 0.98-1.25; p=0.111) or graft failure (HR 1.09, 95% CI 0.96-1.23; p=0.185) but was associated with post-transplant dialysis (OR 1.31, 95% CI 1.03-1.67; p=0.030) and longer index hospitalization (IRR 1.12, 95% CI 1.06-1.18; p<0.001). AICM was also associated with higher malignancy-related mortality compared with idiopathic DCM (sHR 2.27, 95% CI 1.66-3.09; p<0.001) and ICM (sHR 1.70, 95% CI 1.24-2.33; p<0.001). Conclusions:Among selected adult heart transplant recipients, anthracycline-induced cardiomyopathy was not associated with worse post-transplant survival or graft failure compared with idiopathic DCM. However, AICM recipients had higher adjusted odds of post-transplant dialysis, longer index hospitalization, and a greater burden of malignancy-related death, highlighting the need for individualized oncologic and renal-risk assessment in transplant candidates with prior anthracycline exposure.