Trends and outcomes of patients with adult congenital heart disease and pulmonary hypertension listed for orthotopic heart transplantation in the United States

• Published in: The Journal of heart and lung transplantation Vol. 35; no. 5; pp. 619 - 624
• Main Authors: Krishnamurthy, Yamini, BA, Cooper, Lauren B., MD, Lu, Di, MS, Schroder, Jacob N., MD, Daneshmand, Mani A., MD, Rogers, Joseph G., MD, Milano, Carmelo A., MD, Hernandez, Adrian F., MD, MHS, Patel, Chetan B., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2016
• Subjects: Adult; adult congenital heart disease; Heart Defects, Congenital; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Hypertension, Pulmonary; mechanical circulatory support; orthotopic heart transplantation; outcomes; pulmonary hypertension; Retrospective Studies; Surgery; Treatment Outcome; United States; Waiting Lists; mechanical circulatory support; adult congenital heart disease; outcomes; pulmonary hypertension; orthotopic heart transplantation
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2015.12.017

Background Heart transplantation is increasing in patients with adult congenital heart disease (ACHD). In this population, the association of pulmonary hypertension (PH) with post-transplant outcomes is not well-defined. Methods Using data from the United Network for Organ Sharing database (1987 to 2014), we identified ACHD patients listed for heart transplantation, and examined survival between those with and without PH (pre-transplant PH defined as transpulmonary pressure gradient >12 mm Hg). Results Among 983 ACHD patients, 216 (22%) had PH. At time of listing, PH patients had a transpulmonary pressure gradient of 17.0 mm Hg vs 6.0 mm Hg ( p < 0.01) in the no-PH group. Although left ventricular assist device (LVAD) use was infrequent, 3.1% of PH patients were treated with an LVAD versus 6.8% of the no-PH patients. Days from listing to transplant, days from listing to death on the waitlist and length of post-transplant hospitalization were not significantly different between the PH and no-PH groups. However, PH was associated with higher waitlist mortality (HR 1.73, CI 1.25 to 2.41). Pre-transplant PH was not associated with post-transplant mortality at 30 days (HR 0.51, CI 0.23 to 1.13), 1 year (HR 0.68, 95% CI 0.40 to 1.18) or 5 years (HR 0.84, 95% CI 0.55 to 1.29). Conclusions PH is common among ACHD patients listed for transplant and is associated with increased waitlist mortality. Conversely, PH was not associated with worse survival after transplant. Bridge-to-transplant LVAD therapy was uncommon in this ACHD population.