Combined Heart-Lung Transplantation: UNOS Data Analysis for Long-Term Survival Outcome

Abstract

<h3>Purpose</h3> Combined heart-lung transplantation remains the only definitive therapy for patients who have both end-stage heart failure and lung failure. We analyzed UNOS data for combined heart-lung transplant data to understand survival outcomes. <h3>Methods</h3> 1,294 patients underwent simultaneous heart-lung transplantation that were reviewed from the UNOS database between October 1987 and February 2020. Descriptives and frequencies were acquired for the variables height, weight, BMI, gender, ethnicity, age, donor age, ischemic time, length of stay, previous transplant, graft status, and creatinine level at the time of transplant were. Survival outcomes were obtained using a Kaplan-Meier Curve. The impact of all variables on survival outcomes was calculated using a cox regression. Data were expressed as mean ± std (SAS Inc). <h3>Results</h3> Out of 1,294 patients, 43.6% were male, 76.7% were Caucasian, 9.4% were African American, and 9.0% were Hispanic. 1.2% had experienced a previous transplant and 41.2% had a prior graft. Height was 160.0 ± 23.3 cm, weight was 59.1 ± 20.1 kg, BMI was 22.2 ± 4.9, age was 34.5 ± 15.3 years, donor age was 25.8 ± 14.0 years, ischemic time was 3.7 ± 1.2 hours, creatine levels were 1.0 ± .6 mg/dL, and LOS was a median of 26 days. The Kaplan-Meier Survival Curve showed 1, 3, 5, and 10 year survival outcomes of 68.5%, 53.1%, 44.7%, and 29.8% respectively. The cox regression showed a significant change in survival outcome from the inclusion of all variables (p=0.000). Only the variables graft status (p=0.000), donor age (p=0.002), and LOS (p=0.003) were significant. A prior graft increased the hazard ratio to 1.846, while the hazard ratios for donor age and LOS were 1.015 and 1.003 respectively. <h3>Conclusion</h3> In selected patients, for the last resort of the patients with end-stage cardiopulmonary failure, combined heart and lung transplantation remains a viable option for excellent outcomes.