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

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:35

Article

Krishnamurthy, Yamini¹  Cooper, Lauren B.^3,2  Lu, Di^3,2  Schroder, Jacob N.⁴  Daneshmand, Mani A.⁴  Rogers, Joseph G.^3,2  Milano, Carmelo A.^3,2,4  Hernandez, Adrian F.^3,2  Patel, Chetan B.^3,2 

[1] Duke Univ, Sch Med, Durham, NC 27710 USA

[2] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA

[3] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27710 USA

[4] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27710 USA

关键词: adult congenital heart disease;    orthotopic heart transplantation;    outcomes;    pulmonary hypertension;    mechanical circulatory support;   

DOI  :  10.1016/j.healun.2015.12.017

来源: Elsevier

【 摘 要 】

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. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

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