Would access to device therapies improve transplant outcomes for adults with congenital heart disease? Analysis of the United Network for Organ Sharing (UNOS)

Melanie D. Everitt, Amy E. Donaldson, Josef Stehlik, Aditya K. Kaza, Deborah Budge, Rami Alharethi, Emily A. Bullock, Abdallah G. Kfoury, Angela T Yetman

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Patients with congenital heart disease (CHD) now survive into adulthood and often present with end-stage heart failure (HF). HF management and approach to orthotopic heart transplant (OHT) may differ from adults without CHD. We sought to compare OHT waitlist characteristics and outcomes for these 2 groups. Methods: The Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) database was used to identify adults (≥18 years) listed for OHT from 2005 to 2009. The cohort was divided into those with or without CHD. Results: Of 9,722 adults included, 314 (3%) had CHD. Adults with CHD were younger (35 ± 13 vs 52 ± 12 years, p < 0.01) and more often had undergone prior cardiac surgery (85% vs. 34%, p < 0.01). Patients with CHD were less likely to have a defibrillator (44% vs 75%, p < 0.01) or ventricular assist device (5% vs 14%, p < 0.01) and were more likely to be listed at the lowest urgency status than patients without CHD (64% vs 44%, p < 0.01). Fewer CHD patients achieved OHT (53% vs 65%, p < 0.001). Although overall waitlist mortality did not differ between groups (10% vs 8%, p = 0.15), patients with CHD were more likely to experience cardiovascular death (60% vs 40%, p = 0.03), including sudden in 44% and due to HF in 16%. Conclusions: Despite lower urgency status, patients with CHD have greater cardiovascular mortality awaiting OHT than those without. Increased defibrillator use could improve survival to OHT, because sudden death is common. VAD support may benefit select patients, but experience in CHD is limited. Referral to specialized adult congenital heart centers can enhance utilization of device therapies and potentially improve waitlist outcomes.

Original languageEnglish (US)
Pages (from-to)395-401
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number4
DOIs
StatePublished - Apr 1 2011

Fingerprint

Heart Diseases
Transplants
Equipment and Supplies
Therapeutics
Defibrillators
Heart Failure
Heart-Assist Devices
Tissue and Organ Procurement
Mortality
Organ Transplantation
Sudden Death
Thoracic Surgery
Referral and Consultation
Databases
Survival

Keywords

  • congenital heart disease
  • defibrillator
  • heart transplant
  • ventricular assist device

ASJC Scopus subject areas

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

Cite this

Would access to device therapies improve transplant outcomes for adults with congenital heart disease? Analysis of the United Network for Organ Sharing (UNOS). / Everitt, Melanie D.; Donaldson, Amy E.; Stehlik, Josef; Kaza, Aditya K.; Budge, Deborah; Alharethi, Rami; Bullock, Emily A.; Kfoury, Abdallah G.; Yetman, Angela T.

In: Journal of Heart and Lung Transplantation, Vol. 30, No. 4, 01.04.2011, p. 395-401.

Research output: Contribution to journalArticle

Everitt, Melanie D. ; Donaldson, Amy E. ; Stehlik, Josef ; Kaza, Aditya K. ; Budge, Deborah ; Alharethi, Rami ; Bullock, Emily A. ; Kfoury, Abdallah G. ; Yetman, Angela T. / Would access to device therapies improve transplant outcomes for adults with congenital heart disease? Analysis of the United Network for Organ Sharing (UNOS). In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 4. pp. 395-401.
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abstract = "Background: Patients with congenital heart disease (CHD) now survive into adulthood and often present with end-stage heart failure (HF). HF management and approach to orthotopic heart transplant (OHT) may differ from adults without CHD. We sought to compare OHT waitlist characteristics and outcomes for these 2 groups. Methods: The Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) database was used to identify adults (≥18 years) listed for OHT from 2005 to 2009. The cohort was divided into those with or without CHD. Results: Of 9,722 adults included, 314 (3{\%}) had CHD. Adults with CHD were younger (35 ± 13 vs 52 ± 12 years, p < 0.01) and more often had undergone prior cardiac surgery (85{\%} vs. 34{\%}, p < 0.01). Patients with CHD were less likely to have a defibrillator (44{\%} vs 75{\%}, p < 0.01) or ventricular assist device (5{\%} vs 14{\%}, p < 0.01) and were more likely to be listed at the lowest urgency status than patients without CHD (64{\%} vs 44{\%}, p < 0.01). Fewer CHD patients achieved OHT (53{\%} vs 65{\%}, p < 0.001). Although overall waitlist mortality did not differ between groups (10{\%} vs 8{\%}, p = 0.15), patients with CHD were more likely to experience cardiovascular death (60{\%} vs 40{\%}, p = 0.03), including sudden in 44{\%} and due to HF in 16{\%}. Conclusions: Despite lower urgency status, patients with CHD have greater cardiovascular mortality awaiting OHT than those without. Increased defibrillator use could improve survival to OHT, because sudden death is common. VAD support may benefit select patients, but experience in CHD is limited. Referral to specialized adult congenital heart centers can enhance utilization of device therapies and potentially improve waitlist outcomes.",
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AU - Stehlik, Josef

AU - Kaza, Aditya K.

AU - Budge, Deborah

AU - Alharethi, Rami

AU - Bullock, Emily A.

AU - Kfoury, Abdallah G.

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