Purpose: As medical and surgical management of complex congenital heart disease (CCHD) improves, patients may survive into adulthood to suffer from end-stage heart failure and require heart transplantation. CCHD survivors often have increased transplant risk factors, including multiple prior cardiac surgeries and transcatheter interventions, sensitization from homografts and blood products, pulmonary hypertension, liver disease, and protein-losing enteropathy especially with single ventricle Fontan physiology. We describe our program's experience with heart transplantation in adult CCHD survivors.

Methods: We reviewed the records of heart transplant recipients transplanted 2007 – 2016 and compared 20 CCHD patients (3 with heart-liver transplant and 17 with heart alone) to the rest (803 patients) on baseline characteristics and 1-year outcomes: survival, vasculopathy (CAV: stenosis >30%), rejection, and nonfatal major adverse cardiac events (NF-MACE: heart failure, pacemaker, stent, stroke).

Results: CCHD patients were younger (36 vs 57 years), had lower BMI (23 vs 26 kg/m<sup style="color: #212121;">2), and female patients had fewer pregnancies (42% vs 78%). There was no difference in donor age, recipient gender, ischemic time, Status 1A listing, or PRA (11% vs 14%). There was no difference in 1-year survival or freedom from CAV (Table). There was a trend to lower freedom from antibody-mediated rejection and lower freedom from NF-MACE, driven by heart failure, stent, and pacemaker in the CCHD group.

Conclusion: Adult survivors of CCHD have comparable post-transplant survival to non-CCHD patients. This is important as improved management of CCHD will result in more patients surviving to adulthood and requiring advanced heart failure therapies.

CITATION INFORMATION: Kittleson M., Patel J., Kransdorf E., Dimbil S., Levine R., Geft D., Chang D., Czer L., Kobashigawa J., Garg R., Zahn E. Heart Transplantation in Patients with Complex Congenital Heart Disease Am J Transplant. 2017;17 (suppl 3).

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