@article{c64641b7c7a047f0a442347320125ea7,
title = "Outcomes of Multi-Organ Transplant in Adult Patients With Congenital Heart Disease",
abstract = "Background: The prevalence of adult congenital heart disease (ACHD) is increasing in the United States because of improved survival into adulthood. The unique physiology of ACHD commonly leads to multiorgan dysfunction, prompting interest in outcomes after multiorgan (heart+X) transplantation. Methods and Results: We queried the SRTR (Scientific Registry of Transplant Recipients) database to examine 5-year outcomes in ACHD patients (aged ≥18 years) who underwent dual organ (heart+kidney/liver/lung) transplantation between 2000 and 2016. Cox proportional hazards models were constructed to look at survival of dual organ transplant recipients versus heart-only recipients in the ACHD population and heart+lung recipients versus heart-only recipients in the ACHD populations and versus non-ACHD recipients of heart+lung transplant. We then constructed a multivariable model to investigate independent risk factors for 5-year mortality after multiorgan transplant. Overall, 5-year mortality was greater for multiorgan (heart+kidney/liver/lung) transplant compared with heart-only transplant. On further analysis, only heart+lung transplant was associated with increased mortality. Outcomes after heart+lung transplant were no different between the ACHD and non-ACHD population. Risk factors for increased risk of 5-year mortality in ACHD patients after multiorgan transplant included heart+lung transplant, previous cardiac surgery, and severe functional limitation. Conclusions: The mortality risk associated with multiorgan heart transplant in ACHD patients is attributable primarily to heart+lung transplants. Multiorgan transplant in ACHD does not convey increased risk compared with the non-ACHD population. Need for multiorgan transplant should not be an impediment to listing ACHD patients needing a heart transplant.",
keywords = "adult congenital heart disease, heart failure, mortality, multiorgan transplant, transplantation",
author = "Kristen Wong and Kristen Tecson and Ari Cedars",
note = "Funding Information: The data reported here have been supplied by the Hennepin Health Research Institute as the contractor for the SRTR. The interpretation and reporting of these data re the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the US government. Funding Information: In the general non‐ACHD adult US population, existing analyses are similarly consistent with the present findings and suggest a median survival for heart+lung transplant at of 5.8 years in the era between 2004 and 2016. Despite the increased mortality for ACHD patients with combined heart+lung transplant, mortality is no different than in non‐ACHD patients undergoing the same procedure. This is a particularly important finding given that pulmonary arterial hypertension is a common sequelae of congenital heart disease with a prevalence in the ACHD population estimated at 4% to 10%, far exceeding that in the non‐ACHD population. This difference is likely responsible for a significantly greater proportion of ACHD patients undergoing combined heart+lung transplant as opposed to heart‐alone compared with their non‐ACHD counterparts. This speculation is supported by the difference in mean pulmonary arterial pressure in heart+lung versus heart‐alone transplant recipients in the present cohort. Our findings suggest that, similar to what is observed in non‐ACHD patients, ACHD patients with heart+lung transplants have worse outcomes than those receiving heart transplant alone. Recently, Dimopoulos et al examined heart alone versus heart+lung transplants in all CHD patients in England from 1997 to 2015. Our analysis differs from theirs in that ours includes exclusively adult patients from the United States. Similar to findings in the present study, Dimopoulos et al found that heart‐lung transplant significantly increased mortality. Publisher Copyright: {\textcopyright} 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",
year = "2019",
month = nov,
day = "19",
doi = "10.1161/JAHA.119.014088",
language = "English (US)",
volume = "8",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "22",
}