Outcomes in adult congenital heart disease patients undergoing heart transplantation: A systematic review and meta-analysis

Barbara Stella Doumouras, Ana Carolina Alba, Farid Foroutan, Luke Burchill, Anne I. Dipchand, Heather Joan Ross

    Research output: Contribution to journalArticle

    20 Citations (Scopus)

    Abstract

    Background Studies assessing mortality and morbidity in adult transplant recipients with congenital heart disease (CHD) are limited. We conducted a systematic review and meta-analysis comparing post-transplant outcomes in these 2 populations. Methods After conducting an electronic database search, we selected studies evaluating mortality, cause-specific mortality, and risk of reoperation and dialysis in adult CHD vs non-CHD patients. We used random-effects models for the meta-analysis. Results Thirty-day mortality was significantly higher in CHD vs non-CHD patients (risk ratio [RR], 2.18; 95% confidence interval [CI], 1.62–2.93; I2 = 41%). This was influenced by increased mortality in Fontan/Glenn patients compared with non-CHD patients (RR, 3.3; 95% CI, 1.89–5.77; I2 = 0%). Mortality at 1 and 5 years was higher in the CHD population, although neither achieved statistical significance. Ten-year mortality was significantly lower in CHD patients (RR, 0.75; 95% CI, 0.60–0.95, I2 = 42%). Deaths caused by malignancy, infection, rejection, and cardiac allograft vasculopathy were decreased in CHD patients, although only death from malignancy achieved significance. Death secondary to primary graft failure, stroke, and hemorrhage was significantly higher in CHD patients. Risk of reoperation and dialysis were not statistically different between the 2 groups. Conclusions Although adult CHD patients have higher early mortality, post-transplantation long-term survival is superior to non-CHD recipients. The challenge is to identify the CHD patients who will benefit from transplantation vs those who are higher risk.

    Original languageEnglish (US)
    Pages (from-to)1337-1347
    Number of pages11
    JournalJournal of Heart and Lung Transplantation
    Volume35
    Issue number11
    DOIs
    StatePublished - Nov 1 2016

    Fingerprint

    Heart Transplantation
    Meta-Analysis
    Heart Diseases
    Mortality
    Odds Ratio
    Confidence Intervals
    Reoperation
    Dialysis
    Transplantation
    Transplants
    Population
    Allografts
    Neoplasms
    Stroke
    Databases
    Hemorrhage

    Keywords

    • adults
    • congenital heart disease
    • Fontan/Glenn
    • morbidity
    • mortality
    • outcomes
    • transplantation

    ASJC Scopus subject areas

    • Surgery
    • Pulmonary and Respiratory Medicine
    • Cardiology and Cardiovascular Medicine
    • Transplantation

    Cite this

    Outcomes in adult congenital heart disease patients undergoing heart transplantation : A systematic review and meta-analysis. / Doumouras, Barbara Stella; Alba, Ana Carolina; Foroutan, Farid; Burchill, Luke; Dipchand, Anne I.; Ross, Heather Joan.

    In: Journal of Heart and Lung Transplantation, Vol. 35, No. 11, 01.11.2016, p. 1337-1347.

    Research output: Contribution to journalArticle

    Doumouras, Barbara Stella ; Alba, Ana Carolina ; Foroutan, Farid ; Burchill, Luke ; Dipchand, Anne I. ; Ross, Heather Joan. / Outcomes in adult congenital heart disease patients undergoing heart transplantation : A systematic review and meta-analysis. In: Journal of Heart and Lung Transplantation. 2016 ; Vol. 35, No. 11. pp. 1337-1347.
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    abstract = "Background Studies assessing mortality and morbidity in adult transplant recipients with congenital heart disease (CHD) are limited. We conducted a systematic review and meta-analysis comparing post-transplant outcomes in these 2 populations. Methods After conducting an electronic database search, we selected studies evaluating mortality, cause-specific mortality, and risk of reoperation and dialysis in adult CHD vs non-CHD patients. We used random-effects models for the meta-analysis. Results Thirty-day mortality was significantly higher in CHD vs non-CHD patients (risk ratio [RR], 2.18; 95{\%} confidence interval [CI], 1.62–2.93; I2 = 41{\%}). This was influenced by increased mortality in Fontan/Glenn patients compared with non-CHD patients (RR, 3.3; 95{\%} CI, 1.89–5.77; I2 = 0{\%}). Mortality at 1 and 5 years was higher in the CHD population, although neither achieved statistical significance. Ten-year mortality was significantly lower in CHD patients (RR, 0.75; 95{\%} CI, 0.60–0.95, I2 = 42{\%}). Deaths caused by malignancy, infection, rejection, and cardiac allograft vasculopathy were decreased in CHD patients, although only death from malignancy achieved significance. Death secondary to primary graft failure, stroke, and hemorrhage was significantly higher in CHD patients. Risk of reoperation and dialysis were not statistically different between the 2 groups. Conclusions Although adult CHD patients have higher early mortality, post-transplantation long-term survival is superior to non-CHD recipients. The challenge is to identify the CHD patients who will benefit from transplantation vs those who are higher risk.",
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    T1 - Outcomes in adult congenital heart disease patients undergoing heart transplantation

    T2 - A systematic review and meta-analysis

    AU - Doumouras, Barbara Stella

    AU - Alba, Ana Carolina

    AU - Foroutan, Farid

    AU - Burchill, Luke

    AU - Dipchand, Anne I.

    AU - Ross, Heather Joan

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    N2 - Background Studies assessing mortality and morbidity in adult transplant recipients with congenital heart disease (CHD) are limited. We conducted a systematic review and meta-analysis comparing post-transplant outcomes in these 2 populations. Methods After conducting an electronic database search, we selected studies evaluating mortality, cause-specific mortality, and risk of reoperation and dialysis in adult CHD vs non-CHD patients. We used random-effects models for the meta-analysis. Results Thirty-day mortality was significantly higher in CHD vs non-CHD patients (risk ratio [RR], 2.18; 95% confidence interval [CI], 1.62–2.93; I2 = 41%). This was influenced by increased mortality in Fontan/Glenn patients compared with non-CHD patients (RR, 3.3; 95% CI, 1.89–5.77; I2 = 0%). Mortality at 1 and 5 years was higher in the CHD population, although neither achieved statistical significance. Ten-year mortality was significantly lower in CHD patients (RR, 0.75; 95% CI, 0.60–0.95, I2 = 42%). Deaths caused by malignancy, infection, rejection, and cardiac allograft vasculopathy were decreased in CHD patients, although only death from malignancy achieved significance. Death secondary to primary graft failure, stroke, and hemorrhage was significantly higher in CHD patients. Risk of reoperation and dialysis were not statistically different between the 2 groups. Conclusions Although adult CHD patients have higher early mortality, post-transplantation long-term survival is superior to non-CHD recipients. The challenge is to identify the CHD patients who will benefit from transplantation vs those who are higher risk.

    AB - Background Studies assessing mortality and morbidity in adult transplant recipients with congenital heart disease (CHD) are limited. We conducted a systematic review and meta-analysis comparing post-transplant outcomes in these 2 populations. Methods After conducting an electronic database search, we selected studies evaluating mortality, cause-specific mortality, and risk of reoperation and dialysis in adult CHD vs non-CHD patients. We used random-effects models for the meta-analysis. Results Thirty-day mortality was significantly higher in CHD vs non-CHD patients (risk ratio [RR], 2.18; 95% confidence interval [CI], 1.62–2.93; I2 = 41%). This was influenced by increased mortality in Fontan/Glenn patients compared with non-CHD patients (RR, 3.3; 95% CI, 1.89–5.77; I2 = 0%). Mortality at 1 and 5 years was higher in the CHD population, although neither achieved statistical significance. Ten-year mortality was significantly lower in CHD patients (RR, 0.75; 95% CI, 0.60–0.95, I2 = 42%). Deaths caused by malignancy, infection, rejection, and cardiac allograft vasculopathy were decreased in CHD patients, although only death from malignancy achieved significance. Death secondary to primary graft failure, stroke, and hemorrhage was significantly higher in CHD patients. Risk of reoperation and dialysis were not statistically different between the 2 groups. Conclusions Although adult CHD patients have higher early mortality, post-transplantation long-term survival is superior to non-CHD recipients. The challenge is to identify the CHD patients who will benefit from transplantation vs those who are higher risk.

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    KW - congenital heart disease

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    KW - morbidity

    KW - mortality

    KW - outcomes

    KW - transplantation

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