Long-Term Outcomes After Heart-Lung Transplantation: A Contemporary 20-Year Single-Center Experience

(s): We aimed to evaluate long-term outcomes after heart-lung transplantation (HLTx) including comparisons between adult congenital (CHD) and non-congenital (non-CHD) recipients and outcomes before and after implementation of the 2018 United Network for Organ Sharing heart allocation system change.

Consecutive patients undergoing HLTx between February 2006 and February 2026 were retrospectively reviewed. The primary endpoint was overall survival. Secondary endpoints included chronic lung allograft dysfunction (CLAD)-free survival and perioperative outcomes. Kaplan-Meier analysis was used for time-to-event outcomes.

Sixty-two patients underwent HLTx, including 20 (32.3%) with CHD and 42 (67.7%) with non-CHD etiologies. Despite greater operative complexity, perioperative outcomes were comparable between groups, with an overall 30-day mortality of 11.3%. Median overall survival was 7.8 years with estimated 1-, 5-, and 10-year survival of 80.1%, 58.8%, and 37.9%, respectively. Median CLAD-free survival was 5.9 years with estimated 1-, 5-, and 10-year rates of 76.6%, 53.5%, and 24.0%, respectively. Overall and CLAD-free survival were similar between CHD and non-CHD recipients (p=0.151 and p=0.354, respectively). Most late deaths were lung-related (20/27, 74%), whereas cardiac causes were uncommon (1/27, 3.7%), and CAV developed in two patients (3.2%). Recipients transplanted after the allocation change demonstrated improved survival (p=0.022), mainly due to a decline in perioperative mortality from 17.5% to 0% (p=0.044).

Long-term outcomes after HLTx remain primarily limited by CLAD and lung-related complications. Adults with CHD achieved survival comparable to non-CHD recipients. Improved contemporary outcomes appear to be driven predominantly by reduced perioperative mortality.