Current Situation and Prognostic Evolution of Combined Heart-lung Transplantation in a European Union Country

Abstract

Background: This study aims to evaluate the entire experience in heart-lung transplantation (HLTx) in a country of
the European Union with 47 million inhabitants according to the etiologies that motivated the procedure.
Methods: A retrospective study on 1,751 consecutive transplants (HLTx: 78) was performed from 1990 to 2020 in
two centers. Overall survival, adjusted for clinical profile and etiological subgroups, was compared. 7 subgroups were
considered: 1) Cardiomyopathy with pulmonary hypertension (CM + PH). 2) Eisenmenger syndrome. 3) Congenital
heart disease (CHD). 4) Idiopathic pulmonary arterial hypertension (IPAH). 5) Cystic fibrosis. 6) Chronic obstructive
pulmonary disease (COPD)/Emphysema. 7) Diffuse interstitial lung disease (ILD).
Results: Early mortality was 44% and that of the rest of the follow-up was 31%. There were differences between
HTLx and HTx in survival, also comparing groups with a similar clinical profile with propensity score (p= 0.04).
Median survival was low in CM + PH (18 days), ILD (29 days) and CHD (114 days), intermediate in Eisenmenger
syndrome (600 days), and longer in IPAH, COPD/Emphysema and cystic fibrosis.
Conclusion: HLTx has a high mortality. The etiological analysis is of the utmost interest to make the most of the organs
and improve survival.