Adults with congenital heart disease have higher 30-day mortality with transplantation

Adults receiving a transplant because of congenital heart disease are more likely to die within a month than other transplant patients, suggesting that these patients ought to be listed for transplant earlier, a review of registry data shows.

Dr Ryan Davies (Columbia University, New York, NY) and colleagues analyzed records of 41 849 adult patients listed for primary transplantation between 1995 and 2009 in the Thoracic Registry of the United Network for Organ Sharing Standard Transplant and Research Dataset. A subset of 1035 (2.5%) of the patients had congenital heart disease. Previous studies have shown reoperation is independently associated with higher posttransplantation mortality, so the researchers separately analyzed the patients who had had a previous sternotomy operation (1.8% of the congenital heart disease patients) and those who had not (1.2% of the congenital heart disease patients).

Congenital heart disease patients were more likely than the non-congenital heart disease patients to have body-mass index under 18.5 at the time of transplantation and were, on average, younger, with fewer comorbidities. But early mortality among patients with congenital heart disease was higher than for non-congenital heart disease patients. Among those who had had a previous sternotomy surgery, 30-day mortality was 18.9% for congenital heart disease patients and 9.6% for non-congenital heart disease patients (p<0.0001). For those without a previous operation, 30-day mortality was 16.6% vs 6.3%, respectively (p<0.0001). After 10 years, overall survival was almost identical in both congenital heart disease and non-congenital heart disease transplant recipients (53.8% vs 53.6%).

Congenital heart disease patients on the transplant waiting list were less likely to be transplanted than patients whose hearts were failing for other reasons (54.2% vs 63.1%; odds ratio 0.59), but the two-month mortality on the waiting list was similar between groups: 8.6% for congenital heart disease and 7.7% for non-congenital heart disease (p=0.3). "The fact that fewer patients in the congenital heart disease group reach transplantation suggests that decisions regarding the timing of listing, management of waiting-list candidates, and donor selection all need improvement," Davies and colleagues argue.