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. 2024 Sep;38(9):e15447.
doi: 10.1111/ctr.15447.

Procurement Trends, Indications, and Outcomes of Heart-Lung Transplantation in the Contemporary Era

John A Treffalls  1 , Ahmet Bilgili  2 , Zachary Brennan  3 , Omar M Sharaf  2 , Elaine M Griffeth  1 , Qiudong Chen  3 , Kelly Pennington  4 , Philip J Spencer  5 , Mauricio A Villavicencio  1 , Richard C Daly  5 , Sahar A Saddoughi  1   5   6
Affiliations

Procurement Trends, Indications, and Outcomes of Heart-Lung Transplantation in the Contemporary Era

John A Treffalls et al. Clin Transplant. 2024 Sep.

Abstract

Background: Evolving trends in organ procurement and technological innovation prompted an investigation into recent trends, indications, and outcomes following combined heart-lung transplantation (HLTx).

Methods: The United Network for Organ Sharing database was queried for all adult (≥18 years) HLTx performed between July 1, 2013 and June 30, 2023. Patients with previous transplants were excluded. The primary endpoint was the effect of donor, recipient, and transplantation characteristics on 1- and 5-year survival. Secondary analyses included a comparison of HLTx at high- and low-volume centers, an assessment of HLTx following donation after circulatory death (DCD), and an evaluation of HLTx volume over time. Cox proportional-hazards models were used to assess factors associated with mortality. Temporal trends were evaluated with linear regression.

Results: After exclusions, 319 patients were analyzed, of whom 5 (1.6%) were DCD. HLTx volume increased from 2013 to 2023 (p < 0.001). One- and 5-year survival following HLTx was 84.0% and 59.5%, respectively. One-year survival was higher for patients undergoing HLTx at a high-volume center (88.3% vs. 77.9%; p = 0.012). After risk adjustment, extracorporeal membrane oxygenation support 72 h posttransplant and predischarge dialysis were associated with increased 1-year mortality (HR = 3.19, 95% CI = 1.86-5.49 and HR = 3.47, 95% CI = 2.17-5.54, respectively) and 5-year mortality (HR = 2.901, 95% CI = 1.679-5.011 and HR = 3.327, 95% CI = 2.085-5.311, respectively), but HLTx at a high-volume center was not associated with either.

Conclusions: HLTx volume has resurged, with DCD HLTx emerging as a viable procurement strategy. Factors associated with 1- and 5-year survival may be used to guide postoperative management following HLTx.

Keywords: United Network for Organ Sharing (UNOS); donors and donation: donation after circulatory death (DCD); heart (allograft) function/dysfunction; lung (allograft) function/dysfunction; organ procurement.

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References

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