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Heart-lung transplantation in the United Kingdom: Trends and outcomes over 4 decades
Miguel Angel Reyes Roque1, Emre Erturk2, Sally Rushton1
1Statistics and Clinical Research, NHS Blood and Transplant, Bristol, UK.
Insights
Heart-lung transplantation (HLT) use has declined significantly in the UK, with fewer patients receiving this life-saving procedure. Despite improved survival post-transplant, challenges in organ allocation persist for those with end-stage cardiopulmonary disease.
Area of Science:
- Cardiology
- Pulmonology
- Transplantation Medicine
Background:
- Combined en-bloc heart-lung transplantation (HLT) is the optimal treatment for select end-stage cardiopulmonary disease patients.
- Indications and utilization of HLT have evolved over time.
- This study analyzes the changing landscape of HLT in the UK.
Purpose of the Study:
- To report the changing trends in heart-lung transplantation (HLT) in the UK over recent decades.
- To identify factors influencing HLT service organization.
- To assess changes in patient demographics and outcomes.
Main Methods:
- Data extracted from the UK Transplant Registry (1984-2023).
- Analysis included all patients registered for or who underwent HLT.
- Comparison of baseline characteristics and outcomes between pre-2000 and post-2000 eras.
Main Results:
- HLT registrations and transplantations significantly declined post-2000 (473 registrations, 200 transplants) compared to pre-2000 (1,199 registrations, 915 transplants).
- Post-2000 HLT candidates were older, more symptomatic, and had more prior cardiac surgeries; cystic fibrosis indications decreased.
- Waiting list mortality risk exceeded transplant chance in the later era, though median post-transplant survival improved to 7.9 years.
Conclusions:
- Despite declining activity, a substantial need for HLT persists, especially for patients with congenital heart disease and pulmonary hypertension.
- Shifting demographics and high waiting list mortality indicate systemic inefficiencies in organ allocation.
- A revised organ allocation system is crucial for timely and equitable access for high-risk HLT candidates.
Background:
Combined en-bloc heart-lung transplantation (HLT) remains the optimal treatment for selected patients with end-stage cardiopulmonary disease. The indications for and utilization of HLT have changed significantly over time. We report the changing landscape of HLT in the UK over recent decades, identifying factors that may inform future organization of services.
Methods:
Data were extracted from the UK Transplant Registry spanning 1984 to December 2023. All patients who were registered for and/or underwent HLT were included in our analysis. Baseline characteristics and outcomes from listing and transplantation were compared between 2 eras: pre-2000 and post-2000.
Results:
Pre-2000, 1,199 patients were registered for HLT, and 915 received HLT, post-2000, there were 473 registrations and 200 transplantations, reflecting a significant decline in the use of this procedure. Those listed post-2000 were older, more symptomatic, and with more prior cardiac surgeries. Cystic fibrosis, the leading indication pre-2000, declined substantially in the later era. For patients requiring HLT in the later era, the risk of dying on the waiting list exceeded the chance of receiving a transplant. Median post-transplant survival improved from 4.07 (IQR 0.2, 12.3) to 7.9 (IQR 0.8, 21.6) years.
Conclusion:
Although HLT activity has declined, a considerable need remains, particularly among patients with congenital heart disease and pulmonary hypertension. The changes in patient demographics and high waiting list mortality highlight systemic inefficiencies in organ allocation and underscore the need for a revised system to ensure timely and equitable access for this high-risk population.
