Trends and contemporary outcomes of combined heart–lung transplantation

Longitudinal data from a multi-institutional, retrospective, Scientific Registry of Transplant Recipients (SRTR) study, evaluating waitlist and post-transplant outcomes for adult and pediatric first-time combined heart–lung transplantation candidates in the United States, were published in The Journal of Heart and Lung Transplantation by Koh et al. The analysis spanned 1985–2024, stratified across four eras (1985–1996, 1997–2006, 2007–2016, and 2017–2024), and included both adults (n = 2,953) and children (n = 628).  

Key data: Among candidates, 1,322 adults (45%) and 209 children (33%) received combined heart–lung transplantation, while 27% and 37% died on the waitlist, respectively. Waitlist mortality decreased from 35% to 9% in adults and 38% to 22% in children between 1985–1996 and 2017–2024. Mortality 1-year post-transplant decreased across the four transplant eras (1985–1996, 1997–2006, 2007–2016, and 2017–2024) in adults (29%, 26%, 12%, and 8%, respectively; p = 0.02), while rates in children varied by era (18%, 29%, 6%, and 19%, respectively; p = 0.001). In multivariate analysis, 10-year post-transplant survival improved vs the earliest comparator era (1985–1996) in adults and children transplanted in 2007–2016 (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.46–0.72; p < 0.001 and HR, 0.52; 95% CI, 0.29–0.92; p = 0.03). 

Key learning: Over the last 40 years, heart–lung transplantation practices in the United States have evolved, with reduced waitlist mortality and improved post-transplant survival over time.