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Prioritising transplantation for adult congenital heart disease, UK national data

Lookup NU author(s): Dr David Crossland

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Abstract

© 2019Objective: There are no multi-centre data on the outcomes of transplant for adult congenital heart disease (ACHD) outside of North America. The literature has identified a number of concerns for this population such as increased wait-list and early post-operative mortality. We investigated outcomes in a national cohort to see if these problems are replicated outside of America. Methods: Adults (aged ≥16 years) undergoing primary heart transplantation 1995–2014 were identified in the UK Registry and registration, operative and post-transplantation related clinical factors were compared to non ACHD recipients. Results: Of 3026 adults who underwent primary heart transplantation, 134 (4.4%) had ACHD (median age 30 years; 40.3% female). For the ACHD patients listed as urgent status, the time to transplant was not significantly different to non ACHD patients and ACHD were not more likely to die or be removed from the wait list. Despite ACHD recipients having longer hospital stays (27 vs. 22 days; p = 0.003) and worse 90-day survival (79.5% vs. 86.6%; p = 0.02), long-term post-transplantation survival was not significantly different. Creatinine clearance was significantly better in ACHD patients at follow-up. In the last 10 years of our study period, all single ventricle transplants have been restricted to experienced ACHD teams, one year survival for Fontan patients was 89.5%. Conclusions: The use of urgent listing appears to have benefited the ACHD group by allowing equal access to transplantation, and recent concentration of expertise for single ventricle transplants has been associated with excellent early survival.


Publication metadata

Author(s): Burch M, Taylor A, Mehew J, Dominguez T, Crossland D, Lewis C, Taylor R, Clift P, Al-Attar N, Venkateswaran R, Banner N

Publication type: Article

Publication status: Published

Journal: International Journal of Cardiology

Year: 2019

Pages: epub ahead of print

Online publication date: 06/09/2019

Acceptance date: 30/08/2019

ISSN (print): 0167-5273

ISSN (electronic): 1874-1754

Publisher: Elsevier Ireland Ltd

URL: https://doi.org/10.1016/j.ijcard.2019.08.059

DOI: 10.1016/j.ijcard.2019.08.059


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