Specific risk factors for heart-lung transplantation

Heart-lung transplantation (HLTx) has become increasingly rare, with fewer than 50 procedures performed annually worldwide. This decline reflects evolving indications, notably the predominance of Eisenmenger syndrome (ES) complicating congenital heart disease (CHD). HLTx remains a complex procedure associated with significant perioperative and long-term risks, particularly in this patient population.

This review synthesizes current literature and registry data to identify specific risk factors associated with HLTx in its modern indications. It examines changes in patient selection, timing of listing, perioperative challenges, and postoperative outcomes, with a focus on ES and CHD-related cases.

HLTx candidates often present with prior thoracic surgeries, polycythemia, systemic arterial collaterals, and multi-organ dysfunction, all contributing to increased surgical complexity and bleeding risk. Long waitlist times and donor shortages further complicate management. Despite these challenges, recent data from expert centers show improved early survival, with 1-year survival rates exceeding 85%. HLTx may offer protective effects against chronic graft dysfunctions such as bronchiolitis obliterans syndrome and coronary artery vasculopathy compared to isolated organ transplants.

HLTx remains the treatment of choice for select patients with complex cardiopulmonary disease, particularly ES with CHD. Optimizing outcomes requires early referral, careful risk stratification, and management in high-volume expert centers. Advances in surgical techniques and perioperative care have improved survival, but HLTx continues to demand multidisciplinary expertise and individualized patient assessment.