Evolving Indications for Heart-Lung Transplant in Spain |
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| Affiliation: | 1. Heart Failure and Transplantation Unit, La Fe University and Polytechnic Hospital, Valencia, Spain;2. Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain;3. Cardiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain;4. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain;5. Marqués de Valdecilla University Hospital, Santander, Spain;6. Lung Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain;7. Pneumology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain;8. Anesthesiology and Resuscitation Department, La Fe University and Polytechnic Hospital, Valencia, Spain;9. Anesthesiology and Resuscitation Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain;10. Thoracic Surgery Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain;11. Cardiac Surgery Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain;12. Cardiac Surgery Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain;1. General Surgery and Digestive System Department, Regional University Hospital of Málaga, Málaga, Spain;2. General Surgery and Digestive System department, Clinic University Hospital of Málaga, Málaga, Spain;1. Heart Failure and Transplantation Unit, La Fe University and Polytechnic Hospital, Valencia, Spain;2. Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain;3. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Spain;4. Department of Medicine, Universidad de Valencia, Valencia, Spain |
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| Abstract: | BackgroundThe outcomes of heart-lung transplant (HLT) are worse than those of heart transplant (HT) and lung transplant alone; this and the availability of mechanical assistance have meant that the indications for HLT have been changing. This study aims to analyze the evolution of indications for HLT in a country of 47 million inhabitants.MethodsWe performed a retrospective observational study of all HLTs performed in Spain (performed in 2 centers) from 1990 to 2020. The total number of patients included was 1751 (HT 1673 and HLT 78). After clinical adjustment, overall survival was compared between the 2 groups. Seven etiological subgroups were considered within the HLT group: (1) cardiomyopathy with pulmonary hypertension (CM + PH);, (2) Eisenmenger syndrome, (3) congenital heart disease without Eisenmenger syndrome, (4) idiopathic pulmonary arterial hypertension (IPAH), (5) cystic fibrosis, (6) chronic obstructive pulmonary disease (COPD) and/or emphysema), and (7) diffuse interstitial lung disease.ResultsThere were a large number of differences between patients with HLT vs HT. HLT had a 2.69-fold increased probability of death in the first year compared with HT. The indications for HLT have changed over the years. In the recent period the indications are mainly congenital heart disease and Eisenmenger syndrome, with some cases of CM + PH. Other indications for HLT have virtually disappeared, mainly lung diseases (IPAH, COPD, cystic fibrosis). Median survival was low in CM + PH (18 days), diffuse interstitial lung disease (29 days), and ischemic heart disease (114 days); intermediate in Eisenmenger syndrome (600 days); and longer in IPAH, COPD and/or emphysema, and cystic fibrosis.ConclusionsHLT is a procedure with high mortality. This and mechanical assists mean that the indications have changed over the years. Etiological analysis is of utmost interest to take advantage of organs and improve survival. |
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