Thorac Cardiovasc Surg 2017; 65(05): 423-429
DOI: 10.1055/s-0036-1597989
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Examining Mortality and Rejection in Combined Heart–Lung Transplantations

Sagar Kadakia
1  Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States
,
Sharven Taghavi
2  Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
,
Senthil Jayarajan
3  Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
,
Vishnu Ambur
1  Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States
,
Grayson Wheatley
4  Department of Cardiac Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States
,
Larry Kaiser
1  Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States
,
Yoshiya Toyoda
4  Department of Cardiac Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

29 September 2016

05 December 2016

Publication Date:
22 January 2017 (online)

Abstract

Background There is a paucity of data on outcomes related to combined heart–lung transplantations (HLTs). Our objective was to identify variables associated with mortality and rejection in HLT.

Methods The United Network for Organ Sharing database was reviewed for HLT performed between 1993 and 2008. Long-term survivors (survival > 5 years) were compared with short-term survivors (survival < 5 years). Factors associated with rejection were examined. Risk-adjusted multivariable Cox's proportional hazards regression analysis was performed to examine variables associated with mortality and rejection.

Results Multivariable analysis revealed that recipient male gender was associated with mortality at 1 year (hazard ratio [HR]: 1.68, 95% confidence interval [CI]: 1.11–2.54, p = 0.01) and 5 years (HR: 1.41, 95% CI: 1.05–1.89, p = 0.02). Preoperative extracorporeal membrane oxygenation (ECMO) was associated with mortality at 1 year (HR: 7.55, 95% CI: 2.55–22.30, p < 0.01) and 5 years (HR: 3.14, 95% CI: 1.19–8.32, p = 0.02). Preoperative mechanical ventilation (MV) was associated with mortality at 1 year (HR: 3.51, 95% CI: 1.77–6.98, p < 0.01) and at 5 years (HR: 2.70, 95% CI: 1.51–4.85, p < 0.01). Multivariable analysis showed that male gender (HR: 1.78, 95% CI: 1.03–3.09, p = 0.04) and cytomegalovirus (CMV) positivity in the recipient and donor (HR: 3.09, 95% CI: 1.59–6.01, p < 0.01) were associated with rejection. Clinical infection in the donor (HR: 2.05, 95% CI: 1.16–3.61, p = 0.01) was also associated with rejection.

Conclusion Survival was affected by recipient male sex and need for preoperative ECMO or MV. Risk factors for rejection included male sex, CMV positivity in the donor and recipient, and donor with clinical infection.