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Outcomes of Multi‐Organ Transplant in Adult Patients With Congenital Heart Disease
BACKGROUND: The prevalence of adult congenital heart disease (ACHD) is increasing in the United States because of improved survival into adulthood. The unique physiology of ACHD commonly leads to multiorgan dysfunction, prompting interest in outcomes after multiorgan (heart+X) transplantation. METHO...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915296/ https://www.ncbi.nlm.nih.gov/pubmed/31718438 http://dx.doi.org/10.1161/JAHA.119.014088 |
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author | Wong, Kristen Tecson, Kristen Cedars, Ari |
author_facet | Wong, Kristen Tecson, Kristen Cedars, Ari |
author_sort | Wong, Kristen |
collection | PubMed |
description | BACKGROUND: The prevalence of adult congenital heart disease (ACHD) is increasing in the United States because of improved survival into adulthood. The unique physiology of ACHD commonly leads to multiorgan dysfunction, prompting interest in outcomes after multiorgan (heart+X) transplantation. METHODS AND RESULTS: We queried the SRTR (Scientific Registry of Transplant Recipients) database to examine 5‐year outcomes in ACHD patients (aged ≥18 years) who underwent dual organ (heart+kidney/liver/lung) transplantation between 2000 and 2016. Cox proportional hazards models were constructed to look at survival of dual organ transplant recipients versus heart‐only recipients in the ACHD population and heart+lung recipients versus heart‐only recipients in the ACHD populations and versus non‐ACHD recipients of heart+lung transplant. We then constructed a multivariable model to investigate independent risk factors for 5‐year mortality after multiorgan transplant. Overall, 5‐year mortality was greater for multiorgan (heart+kidney/liver/lung) transplant compared with heart‐only transplant. On further analysis, only heart+lung transplant was associated with increased mortality. Outcomes after heart+lung transplant were no different between the ACHD and non‐ACHD population. Risk factors for increased risk of 5‐year mortality in ACHD patients after multiorgan transplant included heart+lung transplant, previous cardiac surgery, and severe functional limitation. CONCLUSIONS: The mortality risk associated with multiorgan heart transplant in ACHD patients is attributable primarily to heart+lung transplants. Multiorgan transplant in ACHD does not convey increased risk compared with the non‐ACHD population. Need for multiorgan transplant should not be an impediment to listing ACHD patients needing a heart transplant. |
format | Online Article Text |
id | pubmed-6915296 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-69152962019-12-23 Outcomes of Multi‐Organ Transplant in Adult Patients With Congenital Heart Disease Wong, Kristen Tecson, Kristen Cedars, Ari J Am Heart Assoc Original Research BACKGROUND: The prevalence of adult congenital heart disease (ACHD) is increasing in the United States because of improved survival into adulthood. The unique physiology of ACHD commonly leads to multiorgan dysfunction, prompting interest in outcomes after multiorgan (heart+X) transplantation. METHODS AND RESULTS: We queried the SRTR (Scientific Registry of Transplant Recipients) database to examine 5‐year outcomes in ACHD patients (aged ≥18 years) who underwent dual organ (heart+kidney/liver/lung) transplantation between 2000 and 2016. Cox proportional hazards models were constructed to look at survival of dual organ transplant recipients versus heart‐only recipients in the ACHD population and heart+lung recipients versus heart‐only recipients in the ACHD populations and versus non‐ACHD recipients of heart+lung transplant. We then constructed a multivariable model to investigate independent risk factors for 5‐year mortality after multiorgan transplant. Overall, 5‐year mortality was greater for multiorgan (heart+kidney/liver/lung) transplant compared with heart‐only transplant. On further analysis, only heart+lung transplant was associated with increased mortality. Outcomes after heart+lung transplant were no different between the ACHD and non‐ACHD population. Risk factors for increased risk of 5‐year mortality in ACHD patients after multiorgan transplant included heart+lung transplant, previous cardiac surgery, and severe functional limitation. CONCLUSIONS: The mortality risk associated with multiorgan heart transplant in ACHD patients is attributable primarily to heart+lung transplants. Multiorgan transplant in ACHD does not convey increased risk compared with the non‐ACHD population. Need for multiorgan transplant should not be an impediment to listing ACHD patients needing a heart transplant. John Wiley and Sons Inc. 2019-11-13 /pmc/articles/PMC6915296/ /pubmed/31718438 http://dx.doi.org/10.1161/JAHA.119.014088 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Wong, Kristen Tecson, Kristen Cedars, Ari Outcomes of Multi‐Organ Transplant in Adult Patients With Congenital Heart Disease |
title | Outcomes of Multi‐Organ Transplant in Adult Patients With Congenital Heart Disease |
title_full | Outcomes of Multi‐Organ Transplant in Adult Patients With Congenital Heart Disease |
title_fullStr | Outcomes of Multi‐Organ Transplant in Adult Patients With Congenital Heart Disease |
title_full_unstemmed | Outcomes of Multi‐Organ Transplant in Adult Patients With Congenital Heart Disease |
title_short | Outcomes of Multi‐Organ Transplant in Adult Patients With Congenital Heart Disease |
title_sort | outcomes of multi‐organ transplant in adult patients with congenital heart disease |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915296/ https://www.ncbi.nlm.nih.gov/pubmed/31718438 http://dx.doi.org/10.1161/JAHA.119.014088 |
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