Combined Heart-Lung Transplantation: A Single-Center Experience of 50 Patients over 30 Years

Abstract

<h3>Purpose</h3> To analyze our institutional outcomes in heart-lung transplantation (HLTx). <h3>Methods</h3> We performed a single-center retrospective analysis of all patients who underwent HLTx at the University Hospitals Leuven (UZL) from 1991 to 2018 and compared our results to ISHLT registry data. <h3>Results</h3> 50 patients underwent HLTx in UZL. In-hospital mortality was 24% vs 72% in the ISHLT database (p<1.10^-5). On average baseline characteristics of donors and receptors were comparable between UZL and ISHLT. Kaplan-Meier survival curves for both are depicted in figure 1. When considering the eras 1991-2003 and 2004-2018, 1-, 5, and 10-year survival rates of UZL were more favorable for the latter era; 15-year survival was significantly better for era 2004-2018, as depicted in figure 2. Over time, we observed an increase in cardiac-related indications with Eisenmenger syndrome being the most important (56% vs 25% in the ISHLT registry, p<1.10^-5). Other forms of pulmonary arterial hypertension (PAH) were an important indication to perform HLTx (24% in both groups). The major cause of late mortality in our population was rejection (41.4%), more specifically chronic lung allograft dysfunction. <h3>Conclusion</h3> Between 1991 and 2018, we performed 50 HLTx's. The most frequent indication was Eisenmenger syndrome, but with a twofold higher proportion in our population compared to the ISHLT registry. The proportion of other forms of PAH was comparable. While over time the indications shifted from pulmonary to cardiac conditions, our survival continues to improve.