Heart or heart-lung transplantation for patients with congenital heart disease in England

Abstract

BackgroundIncreased longevity in patients with congenital heart disease (CHD) is associated with late complications, mainly heart failure, which may not be amenable to redo surgery and become refractory to medical therapy and so, trigger referral for transplantation. We assessed the current role and future prospects of heart and heart-lung transplantation for patients with CHD in England.MethodsWe performed a retrospective analysis of hospital episodes for England for 1997–2015, identifying patients with a CHD code (ICD-10 ‘Q2xx.x’), who underwent heart or heart-lung transplantation.ResultsIn total, 469 transplants (82.2% heart and 17.8% heart-lung) were performed in 444 patients. Half of patients transplanted had mild or moderate CHD complexity, this percentage increased with time (p=0.001). While overall, more transplantations were performed over the years, the proportion of heart-lung transplants declined (p<0.0001), whereas the proportion of transplants performed in adults remained static. Mortality was high during the first year, especially after heart-lung transplantation, but remained relatively low thereafter. Older age and heart-lung transplantation were strong predictors of death. While an increase in CHD transplants is anticipated, actual numbers in England seem to lag behind the increase in CHD patients with advanced heart failure.ConclusionsThe current and future predicted increase in the numbers of CHD transplants does not appear to parallel the expansion of the CHD population, especially in adults. Further investment and changes in policy should be made to enhance the number of donors and increase CHD transplant capacity to address the increasing numbers of potential CHD recipients and optimise transplantation outcomes in this growing population.

Transplantation: the final hurdle to longevity in patients with congenital heart disease

“…This falls well short of the need for growth in the CHD population suggested by Dimopoulos et al 4. An increase in transplants in patients with CHD can be achieved only if donor numbers increase with a similar proportion allocated to patients with CHD or the proportion of transplants performed for CHD increases.…”

“…The alternative of increasing the proportion of transplants for CHD requires consideration. Dimopoulos et al report 469 transplants over an 18-year period 4. Over the same period, 3352 HT (n=3053) and HLTs (n=299) were performed in the UK,5 providing a proportion of 14%, well above that reported by the International Registry.…”

“…More than 90% of patients born with CHD are now expected to survive into adulthood2 with an estimated prevalence of CHD in adults of approximately 3000 per million population 3. These patients have benefited from advances in surgical technique and medical therapy, delaying the onset of univentricular or biventricular failure, arrhythmias, pulmonary hypertension and multiorgan failure to an older age 4. Not only does this growing population increase the need for HT but also adds to the diversity and complexity of transplant surgery and immediate postoperative care.…”

“…In their  Heart  paper, Dimopoulos and colleagues report the English experience of HT and combined heart/lung transplantation (HLT) in patients with CHD 4. Over an 18-year period, 469 transplants were performed in 444 patients—with most (82.2%) isolated HT.…”

Heartbeat: Bicuspid aortic valve heritability and association with aortopathy

“…Both an original research article5 and an editorial6 in this issue address the increasing use of heart or heart-lung transplantation for patients with congenital heart disease (CHD). Compared with other types of end-stage heart disease, those with CHD in the UK are less likely to receive a heart transplant or mechanical circulatory support.…”