Abstract 11846: Factors Influencing Survival in Adult Patients With Congenital Heart Disease Considered for Transplant: A Single Center Study

Abstract

Introduction: Adult congenital heart disease (ACHD) patients pose unique challenges in identifying time for transplantation and factors influencing outcomes. Hypothesis: Survival outcomes in ACHD patients depend on hemodynamic, functional, and laboratory parameters. Methods: We performed a retrospective chart review of adult patients (>18y) with CHD evaluated for heart or heart+ transplant between November 2004 and July 2014 and evaluated outcomes until December 2020 at University of Pittsburgh Medical Center. Multiple clinical parameters were evaluated to identify factors influencing outcomes for up to 10 years after consideration for transplant. Kruskal-Wallis nonparametric analysis was conducted to compare differences between variables. Results: 58 adult patients with congenital heart disease (CHD), age range 20-55 years were evaluated. D-TGA with atrial switch operation (20.7%), tetralogy of Fallot/pulmonary atresia (15.5%) and tricuspid atresia (13.8%) were the most common diagnosis for transplant. Of the 58 patients, 5 (8.6%) were deferred, 42 (72.4%) were listed for transplant and 11 (18.9%) were declined for transplant. Statistically significant factors affecting listing decision are included in table 1. Declined patients showed the highest 1-year mortality (18.2%), whereas waitlisted patients showed the highest 10-year mortality (84.2%). In the post-transplantation period, 30 day survival was 87.0%, 1-yr was 82.6%, and 5-yr and 10 year was 69.6%. 1-year post-transplant survival was influenced by pre-transplant end diastolic pressures, use of advanced life support, and right atrial pressure. There was no significant difference in post-transplant survival between single ventricle versus bi-ventricular patients. Conclusions: We have identified clinical factors that influence survival outcomes in ACHD patients considered for transplantation, These can applied while making transplant decisions and improve outcomes