Prognosis factors in heart-lung transplantation: 30 years experience in a reference center

• Published in: Cirugia española (English ed.) Vol. 102; no. 1; pp. 11 - 18
• Main Authors: Ochoa, Carlos Ordoñez, Navarro, Jose Cerón, Ávila, Olga Salamea, Bellorín, Alilis Fontana, Gonzalez, Stephania Aguilar, Aixelá, Alfonso Morcillo, Aragón, Carlos Jorda, Badia, Gabriel Sales
• Format: Journal Article
• Language: English
• Published: Spain 01-01-2024
• Subjects: Heart-Lung Transplantation; Humans; Ischemia; Male; Prognosis; Retrospective Studies; Survival Rate; Heart-Lung transplantation; Congenital heart defect; Mortality; Mortalidad; Cardiopatías congénitas; Hipertensión arterial pulmonar; Pulmonary arterial hypertension; Eisenmenger syndrome; Síndrome de eisenmenger; Survival; Supervivencia; Trasplante de corazón-pulmón
• DOI: 10.1016/j.cireng.2023.08.004
• EISSN: 2173-5077

Heart-lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital.
We performed a retrospective study of a historical cohort of heart-lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ
test or Fisher's exact test. Survival was analyzed using the Kaplan-Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method.
A decrease in the number of procedures performed in the last decade was observed [2000-2009: 19 procedures (44.2%); 2010-2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010. Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005). Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005).
There has been a progressive decrease in the number of heart-lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.