Specific risk factors for heart-lung transplantation

Justin Issard^{1

2}, Jérôme Le Pavec³, Gaelle Dauriat³, Estibaliz Valdeolmillos⁴, Sébastien Hascoet⁴, Jean Noel Andarelli⁵, Sylvain Diop⁶, Thibaut Genty⁶, Laurent Savale⁷, Olaf Mercier^{1

2}, Elie Fadel^{1

2}

Affiliations

¹ Inserm UMR_S 999 (Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovations), Paris-Saclay University, Le Plessis-Robinson, France.
² Thoracic Surgery and Heart-Lung Transplantation, Thoracic Department, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis-Robinson, France.
³ Pulmonology and Lung Transplantation, Thoracic Department, Marie-Lannelongue Hospital, Inserm UMR_S 999 (Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovations), Paris-Saclay University, Le Plessis-Robinson, France.
⁴ Department of Congenital Heart Diseases, M3C Referral Center for Complex Congenical Heart Diseases, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France.
⁵ Interventional Radiology, Thoracic Department, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis Robinson, France.
⁶ Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France.
⁷ Department of Respiratory and Intensive Care Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), ERN-LUNG, Pulmonary Hypertension National Referral Center, Bicêtre University Hospital, Inserm UMR_S 999 (Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovations), Paris-Saclay University, Le Kremlin-Bicêtre, France.

PMID: 41103489
PMCID: PMC12524542
DOI: 10.1016/j.jhlto.2025.100389

Specific risk factors for heart-lung transplantation

Justin Issard et al. JHLT Open. 2025.

. 2025 Sep 17:10:100389.

doi: 10.1016/j.jhlto.2025.100389. eCollection 2025 Nov.

Authors

Affiliations

¹ Inserm UMR_S 999 (Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovations), Paris-Saclay University, Le Plessis-Robinson, France.
² Thoracic Surgery and Heart-Lung Transplantation, Thoracic Department, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis-Robinson, France.
³ Pulmonology and Lung Transplantation, Thoracic Department, Marie-Lannelongue Hospital, Inserm UMR_S 999 (Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovations), Paris-Saclay University, Le Plessis-Robinson, France.
⁴ Department of Congenital Heart Diseases, M3C Referral Center for Complex Congenical Heart Diseases, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France.
⁵ Interventional Radiology, Thoracic Department, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis Robinson, France.
⁶ Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France.
⁷ Department of Respiratory and Intensive Care Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), ERN-LUNG, Pulmonary Hypertension National Referral Center, Bicêtre University Hospital, Inserm UMR_S 999 (Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovations), Paris-Saclay University, Le Kremlin-Bicêtre, France.

PMID: 41103489
PMCID: PMC12524542
DOI: 10.1016/j.jhlto.2025.100389

Abstract

Background: Heart-lung transplantation (HLTx) has become increasingly rare, with fewer than 50 procedures performed annually worldwide. This decline reflects evolving indications, notably the predominance of Eisenmenger syndrome (ES) complicating congenital heart disease (CHD). HLTx remains a complex procedure associated with significant perioperative and long-term risks, particularly in this patient population.

Methods: This review synthesizes current literature and registry data to identify specific risk factors associated with HLTx in its modern indications. It examines changes in patient selection, timing of listing, perioperative challenges, and postoperative outcomes, with a focus on ES and CHD-related cases.

Results: HLTx candidates often present with prior thoracic surgeries, polycythemia, systemic arterial collaterals, and multi-organ dysfunction, all contributing to increased surgical complexity and bleeding risk. Long waitlist times and donor shortages further complicate management. Despite these challenges, recent data from expert centers show improved early survival, with 1-year survival rates exceeding 85%. HLTx may offer protective effects against chronic graft dysfunctions such as bronchiolitis obliterans syndrome and coronary artery vasculopathy compared to isolated organ transplants.

Conclusions: HLTx remains the treatment of choice for select patients with complex cardiopulmonary disease, particularly ES with CHD. Optimizing outcomes requires early referral, careful risk stratification, and management in high-volume expert centers. Advances in surgical techniques and perioperative care have improved survival, but HLTx continues to demand multidisciplinary expertise and individualized patient assessment.

Keywords: Eisenmenger syndrome; congenital heart disease; heart-lung transplantation; specific risk determinant; survival.

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Conflict of interest statement

The authors declare that they have no conflict of interest. Funding: None.

Figures

**Figure 1**
Computed tomography angiogram of the chest showing hypertrophic systemic bronchial and nonbronchial arteries in a patient with Eisenmenger syndrome complicating an uncorrected ventricular septal defect.

See this image and copyright information in PMC

References

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Specific risk factors for heart-lung transplantation

Affiliations

Specific risk factors for heart-lung transplantation

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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