Introduction: The congenital heart disease (CHD) population continues to expand as outcomes of CHD improve and more patients survive into adulthood. Many of these patients have undergone palliated surgical repair and present with unique complications from their failing cardiac physiology. A subset of this population may warrant consideration for combined heart-liver transplant (HLT). Survival after HLT in CHD patients has not been described. We compared HLT outcomes in CHD patients to non-CHD patients and identified predictors of post HLT survival.
Methods: The Organ Procurement and Transplantation Network database was queried for HLT recipients from 1987 to 2016. Survival after HLT in patients with and without CHD was compared using Cox proportional hazard modeling and depicted using a Kaplan Meier plot. Univariate and multivariate Cox regression analyses were performed to determine donor and recipient predictors of survival post HLT.
Results: During the study period, 223 patients underwent HLT. Of these, 48 were listed with diagnosis of CHD and 175 were non-CHD patients, with amyloidosis being the most common non-CHD diagnosis (n=54). For the entire cohort, survival after HLT was 87% at 1 year, 82% at 5 years and 59% at 10 years. On multivariate analysis, only recipient age (adjusted HR 1.04; 95% CI 1.01-1.07) and donor CDC High Risk category for blood borne disease transmission (2.70; 1.00-7.38) were risk factors for mortality. Cox proportional hazard modeling showed no difference in post HLT survival in CHD compared to non-CHD patients (Figure).
Conclusions: We find no difference in post HLT survival in CHD compared to non-CHD patients. Additionally, survival after HLT is similar to previously reported survival after isolated heart transplantation in adults. In carefully selected patients, HLT may be a viable option with acceptable outcomes. These data indicate that the diagnosis of CHD should not be a deterrent to performing HLT in an otherwise suitable candidate.