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Researchers document post-transplantation mortality rates in adults with congenital heart disease
Davies R. Circulation. 2011;123;759-767.
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Following a high short-term mortality, patients with congenital heart disease had better late survival after heart transplantation, according to researchers.
The study involved 41,849 patients older than 18 years who were listed for primary transplantation between 1995 and 2009. Investigators compared patients with a history of congenital heart disease (CHD; n=1,035) with those with non-CHD causes (n=40,814). Of the study patients, 26,055 reached transplantation, with 10,484 having and 15,571 not having prior sternotomy.
According to study data, survival was comparable between CHD and non-CHD arms, although among CHD patients, mechanical ventricular assistance was not linked with superior survival to transplantation. Also reported among CHD patients was a higher likelihood of having a BMI of less than 18.5 at transplantation, fewer comorbidities and a younger age.
Researchers looked at early mortality rates and found a significantly higher rate among patients with CHD in both the reoperation arm (18.9% vs. 9.6%; P<.0001) and the non-reoperation arm (16.6% vs. 6.3%; P<.0001), despite a nearly equal mortality rate at 10 years (CHD, 53.8% vs. non-CHD, 53.6%).
In the study’s clinical perspective, the researchers wrote that improving the understanding of the differences between CHD and non-CHD patients may enable improvements in the outcomes of this increasingly important population.
“The increasingly common transplantation of patients with complex CHD may result in particularly high post-transplantation mortality, and centers performing these transplantations should proceed with caution,” they said. “Collection of data specific to the CHD population, including accurate congenital diagnoses, is essential to better understand and improve the outcomes with transplantation in this population.”
The paper by Davies and colleagues is a significant review of over 1,000 congenital heart disease patients who develop advanced HF that requires cardiac transplantation. This is the first look into these patients in a large registry from the United Network for Organ Sharing. It is noteworthy that patients with CHD are living longer and as many as 10-20% of CHD patients will eventually require cardiac transplantation. As seen in previous smaller studies, early mortality after transplant is high but it is comforting to know (from this study) that late survival is better than that among non-CHD patients. The CHD patients are, in general, younger and I believe they are more resilient to recover from complications. A major limitation from this study is that the specific CHD abnormality was not available through the UNOS Registry. Therefore, accurate outcomes of specific CHD diagnoses was not possible to determine. This will be important for future studies as specific CHD diagnoses may have different outcomes.
– Jon Kobashigawa, MD
Cardiology Today Editorial Board
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