Non-Fontan Adult Congenital Heart Disease Transplantation Survival Is Equivalent to Acquired Heart Disease Transplantation Survival

Abstract

With careful donor and recipient selection, adults with end-stage CHD undergoing HT can achieve excellent early and midterm survival, comparable to the survival of patients who undergo transplantation for other diagnoses.

Outcomes in adult congenital heart disease patients undergoing heart transplantation: A systematic review and meta-analysis

“…The search yielded 4,053 studies, with thirteen studies fulfilling the inclusion critieria, [11][12][15][16][17][18][19][20][21][22][23][24][25] (Figure 1) all retrospective, unmatched cohort studies. Nine single centre and four registry studies were included, consisting of 899 CHD and 43,452 non-CHD patients.…”

Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement on Heart Transplantation: Patient Eligibility, Selection, and Post-Transplantation Care

“…There are no published evidence-based or consensus guidelines regarding adult congenital heart disease (ACHD) patients and HTx. Prognostication is difficult because most of the data are derived from retrospective single-centre [48][49][50][51][52][53][54][55][56][57][58][59] or registry-based studies [60][61][62][63][64][65][66][67][68][69][70] with no randomized trials and only 1 meta-analysis published to date. 71 Timing of referral for HTx assessment is difficult because of the lack of robust data correlating any specific factors with outcomes.…”

“…Ischemic time has been shown to be a risk factor for early mortality in ACHD transplant recipients. 49,50 Increasing ischemic time is associated with reduced survival, and the probability of death is further increased in the older recipient with an older donor and longer ischemic time. 69 ACHD transplant recipients have increased perioperative and early post-transplantation mortality, 60,61,66,[69][70][71] due to hemorrhage, renal failure, multisystem organ failure, and primary graft failure.…”

“…70,71 However, they have better long-term survival and outcomes because of younger age, fewer comorbidities, and reduced risk for infection. 49,50,60,61,[69][70][71] Combined solid organ transplantation Combined organ transplantation volumes have increased over the past several years, but continue to represent a very small proportion of overall HTx. In the 2016 ISHLT registry, heart-kidney transplantation (HKT) and HLivT accounted for approximately 4% of all HTxs, and heart-lung transplantation (HLungT) accounted for < 2% of all lung transplants performed.…”

The right time for ischemic time?

“…2,3 Through clinical experience and analysis, the general convention has been that up to 4 h of ischemia time can be tolerated. [4][5][6][7] Ischemic times beyond this threshold have largely been associated with worsened clinical outcomes. 8,9 In that regard, Tang et al are to be commended on this analysis and for being willing to report an outcome that would go against the established norm.…”