The University of North Carolina Heart-Lung Transplant Experience: Historical Perspective and Notes on Surveillance for Very Long-Term Survivors

Background: The University of North Carolina (UNC) pioneered heart-lung transplant (HLT) in the state of North Carolina in 1991. Specific guidelines for surveillance of very long-term survivors of HLT are non-existent. We report historical context for the UNC 30-year experience with HLT, complexity of subsequent medical care, and a standardized approach to follow-up. Methods: The medical and UNOS records for all patients who underwent HLT at UNC were reviewed. Demographics, perioperative details, and post-transplant medication regimens were abstracted. Early (30 day) and late (>30 days post HLT) morbidity was described, and Kaplan-Meier curves estimated long-term survival. Results: Overall, 15 patients (67% male, 73% adults) underwent HLT, and 80% had congenital heart disease. Five-, twenty-, and twenty-five-year survival was 40% (n=6), 27% (n=4), and 20% (n=3), respectively. All 15-year survivors (n=5) experienced late complications (infections-100%; chronic kidney disease-60%; malignancies-40%; and pulmonary allograft rejection-60%). None had cardiac graft rejection. Dedicated transplant cardiologists and pulmonologists directed long-term care, and survivors were followed every 6-12 months with non-invasive cardiopulmonary testing. Invasive testing with cardiac catheterization and/or bronchoscopy was performed every 2-3 years. Limitations: Limitations of the study include small sample size typical of a single-center study. However, this historicallysignificant series represents the entire HLT experience at UNC. Conclusion: UNC pioneered HLT in the state of North Carolina in 1991. HLT remains a rarely-performed, but viable option for end-staged cardiopulmonary failure as evidenced by favorable long-term survival. Late complications are common and warrant close surveillance and ongoing coordinated care by a specialized multi-disciplinary team.