Survival After Heart Transplant for Previously Palliated Complex Congenital Cardiac Patients

Patients with congenital heart disease (CHD) are living longer after palliative repair operations. Many of these patients will eventually need a heart transplant (tx) and possible multi-organ txs. Knowledge about heart tx outcomes for this patient population is limited. We believe heart tx is possible in this patient population with successful outcomes. Data was collected from the United Network for Organ Sharing (UNOS) registry database from 1985 - present. Inclusion criteria were: heart transplant recipients with a diagnosis of CHD, prior cardiac surgery and age at tx was between 2-35 years (y). Descriptive statistics were calculated and survival outcomes were analyzed utilizing the Kaplan-Meier method. The following variables were evaluated: device support prior to tx, waitlist time, ischemic time, survival and rejection episodes. Ninety-nine (99) patients were identified who met the inclusion criteria. All patients were transplanted after 2003; 36 (36.4%) were female and 74 (74.7%) were Caucasian. Thirty-seven (37.4%) patients were on mechanical circulatory support prior to tx. Age at time of transplant ranged from 2-35y (mean 17; median 19). Days on the waiting list ranged from 2-1147 (mean 165; median 68). Ischemic time ranged from 1.3-6.6 hours (mean 3.7; median 3.8). Two of the 99 patients received a heart-lung tx, 3 received a heart-liver tx, 1 received a heart-kidney tx and the remaining 93 recipients received an isolated heart tx. Twenty-four recipients had an acute episode of rejection and 30 were treated for rejection within the 1st year after tx. Sixty-eight patients (68.7%) survived and are alive currently, 75% of recipients survived 2 years, and 67% survived 5 years after tx. (Figure 1) CHD patients, following palliative and multi-stage repair operations often progress to heart failure requiring heart tx. Some patients require multi-organ tx. By analyzing the UNOS database, this group of patients have good survival following heart transplantation.