Post-Heart Transplant (HT) Survival for Adult Congenital Heart Disease (ACHD)

Purpose We sought to characterize the ACHD HT experience at a single referral institute. Methods and Materials We analyzed our HT database. All OHT patients aged ≥ 18 years from 2001-2011 were included. Longitudinal survival was examined with Kaplan-Meier & adjusted Cox PH regression. Follow-up time was censored at 1 year. Data from UNOS registry (2001-2011) was compared. Results In our institution, 728 HT patients were identified, with 699 non-ACHD & 29 ACHD. Overall, 34.6% were ischemic & 65.4% were non-ischemic. Overall age was 52.4 ± 13.8 years, with ACHD younger than non-ACHD (34.9 ± 14.6 versus 53.1 ± 13.3, p Figure 1a ). After adjusting for age, ACHD had worse survival at 30 days [OR 5.3 (95% CI 1.0-28.7), p = 0.05], 60 days [5.7 (1.4-22.7), 0.015], & 6 months [3.9 (1.3-12.1), 0.017]. This difference resolved at 1 year [1.8 (0.6-5.3), 0.277]. In UNOS, there were 465 ACHD HT-only from 2001-2011. When comparing our experience to UNOS ( Figure 1b ), there was no significant difference, but an apparent trend toward improved survival in our ACHD cohort (30-, 60- & 365-day survival of 84.2%, 81.9%, & 77.4%). Conclusions Management of ACHD patients with heart failure remains challenging with OHT as a viable strategy for end-stage disease. In our experience, ACHD patients have increased mortality early post-transplant that persists to 6 months. However, ACHD patients have similar survival by 1 year. When compared to UNOS ACHD, there was no significant difference in survival for 2001-2011, although a trend toward improved survival existed despite a complex referral base.