Evolving Indications for Heart-Lung Transplant in Spain

Area of Science:

• Cardiology
• Thoracic Surgery
• Transplantation Medicine

Background:

• Heart-lung transplant (HLT) outcomes are poorer than heart transplant (HT) or lung transplant alone.
• Evolving indications for HLT are influenced by mechanical assistance availability.
• This study analyzes HLT indication trends in Spain (47 million inhabitants).

Purpose of the Study:

• To analyze the evolution of indications for heart-lung transplant (HLT).
• To compare outcomes between HLT and heart transplant (HT) patients.
• To examine survival rates across different etiological subgroups of HLT.

Main Methods:

• Retrospective observational study of HLTs in Spain (1990-2020).
• Included 1751 patients: 1673 HT and 78 HLT.
• Compared overall survival between HLT and HT groups, analyzing seven etiological subgroups for HLT.

Main Results:

• HLT patients had a 2.69-fold higher probability of 1-year mortality compared to HT.
• Recent HLT indications are primarily congenital heart disease and Eisenmenger syndrome.
• Lung disease indications (IPAH, COPD, cystic fibrosis) have significantly decreased.

Conclusions:

• Heart-lung transplant (HLT) is associated with high mortality.
• Shifting indications for HLT are driven by mortality and mechanical assist advancements.
• Etiological analysis is crucial for optimizing organ utilization and improving HLT survival rates.