Etiology of Failure Predicts Heart-Lung Transplant Candidate's Waitlist Survival

Abstract

Purpose Predictors of waitlist (WL) mortality for heart-lung transplant (HLT) has not previously been analyzed. We hypothesized that etiology of failure would be a predictor of mortality prior to receiving a HLT. Methods Pediatric ( multivariate analysis . Results There were 604 HLT candidates identified, 34% (n=206) of whom were transplanted. Only 26% of patients received a transplant by 1 year on the WL with 30% dying. Median time to transplant was 131 days. Diagnoses were Primary Pulmonary Hypertension (IPAH) (n=142), Congenital Heart Disease (CHD) without Eisenmenger Syndrome (ES) (n=67), CHD with ES (n=74), and Other(n=321). Waitlist survival by diagnosis is displayed by Figure 1. There was no significant difference in wait time among the groups (p>0.05) and time on waitlist did not impact post-transplant survival for any diagnosis. On multivariate analysis (Table 1), risk factors for mortality at 6-months included a diagnosis other than CHD with ES (OR: 6.35, 95% CI: 1.9-21.2, p=0.003), IV inotropes (OR: 2.86, 95% CI: 1.58-5.18, p=0.001), and being an infant (OR: 2.44, 95% CI: 1.42-4.18, p=0.001). Conclusion Diagnosis is the most important predictor of WL mortality in heart-lung transplantation . Despite similar waiting times to other diagnoses, patients with CHD with ES are the most likely to survive to HLT.