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 language | English (US) |
|---|---|
| Pages (from-to) | 1337-1347 |
| Number of pages | 11 |
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 35 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2016 |
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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 journal › Article
}
TY - JOUR
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
PY - 2016/11/1
Y1 - 2016/11/1
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.
KW - adults
KW - congenital heart disease
KW - Fontan/Glenn
KW - morbidity
KW - mortality
KW - outcomes
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=84994429459&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84994429459&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2016.06.003
DO - 10.1016/j.healun.2016.06.003
M3 - Article
C2 - 27431751
AN - SCOPUS:84994429459
VL - 35
SP - 1337
EP - 1347
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 11
ER -