Examining Long-Term Survivors in Combined Heart-Lung Transplantation

S. Kadakia,¹ S. Jayarajan,¹ S. Taghavi,¹ V. Ambur,¹ C. Lewis,¹ A. Shiose,² G. Wheatley III,² L. Kaiser,³ T. Guy,² Y. Toyoda.²

¹Department of Surgery, Temple University Hospital, Philadelphia, PA
²Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA
³Division of Thoracic Surgery, Temple University Hospital, Philadelphia, PA.

Meeting: 2015 American Transplant Congress

Abstract number: 72

Keywords: Heart/lung transplantation, Multivariate analysis, Risk factors, Survival

Session Information

Session Name: Concurrent Session: "The Pit and the Pendulum": VADs, Dual Organs and Other Matters of the Heart

Session Type: Concurrent Session

Date: Sunday, May 3, 2015

Session Time: 2:15pm-3:45pm

Presentation Time: 2:51pm-3:03pm

Location: Room 119-B

The goal of this study was to determine variables associated with mortality in combined heart-lung transplantation (HLT).

The United Network for Organ Sharing (UNOS) database was retrospectively reviewed for all patients who underwent combined HLT from 1993-2008. Long-term survivors (>5 years) were compared to short-term survivors. Risk-adjusted multivariable Cox proportional hazards regression analysis was used to examine variables associated with mortality.

In our study, 264 (46.2%) patients survived greater than 5 years and 307 (53.8%) survived less than 5 years. The long term survivors had decreased needs for ECMO (0.8% vs. 2.9%, p=0.006) and mechanical ventilation (1.9% vs. 6.2%, p=0.006) as a bridge to transplantation. The recipient characteristics were not different with respect to age (39.1 vs. 38.2 years, p=0.36), male gender (36.7% vs. 42%, p=0.20), BMI (23.0 vs. 22.5, p=0.22), baseline creatinine (1.1 vs. 1.1 mg/dL, p=0.506), history of diabetes (2.0% vs. 1.7%, p=0.78), mean ischemic time (3.9 vs. 3.9 hours, p=0.85), and total HLA mismatch (4.5 vs. 4.7, p=0.08). The donor characteristics were not different with respect to male gender (50% vs. 49.8%, p=0.97), BMI (23.4 vs. 23, p=0.44), history of diabetes (2.2% vs. 2.5%, p=0.79), and white ethnicity (69.3% vs. 71.7%, p=0.25). Length of stay (33.4 vs. 43 days, p=0.09) and requirement for retransplantation (1.5% vs. 1.6%, p=0.82) were not different. On multivariate analysis, recipient male gender was associated with increased mortality at 1-year (HR 1.679, 95% CI 1.11-2.54, p=0.01) and 5-years (HR 1.41, 95% CI 1.05-1.89, p=0.021) post-transplantation. In addition, the use of ECMO as a bridge to transplantation was associated with mortality at 1-year (HR 7.55, 95% CI 2.55-22.30, p<0.001) and 5-years (HR 3.14, 95% CI 1.19-8.32, p=0.02). Mechanical ventilation as a bridge to transplantation was also associated with mortality at 1-year (HR 3.51, 95% CI 1.77-6.98, p<0.001) and at 5-years (HR 2.70, 95% CI 1.51-4.85, p<0.001).

In patients undergoing combined HLT, both short and long term survival was adversely affected by recipient male sex and the need for preoperative ECMO or mechanical ventilation.

To cite this abstract in AMA style:

Kadakia S, Jayarajan S, Taghavi S, Ambur V, Lewis C, Shiose A, III GWheatley, Kaiser L, Guy T, Toyoda Y. Examining Long-Term Survivors in Combined Heart-Lung Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/examining-long-term-survivors-in-combined-heart-lung-transplantation/. Accessed November 24, 2024.

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