Longitudinal trends and contemporary outcomes of combined heart-lung transplantation

BACKGROUND: After a gradual decline in the number of combined heart-lung transplants (HLTxs) in the United States, there has been a rise in the number being performed since 2014, especially among adults. To better understand the shifting landscape of HLTx, we investigated the evolution of HLTx in the United States over the past 40 years among first-time adult and pediatric HLTx candidates. We explored clinical characteristics between those who received HLTx and those who were removed from or died on the waitlist. We further identified risk factors for post-HLTx mortality. METHODS: First-time HLTx candidates of all ages were identified in the Scientific Registry of Transplant Recipients. We examined waitlist and post-transplant outcomes across 4 eras: 1985-1996, 1997-2006, 2007-2016, and 2017-2024. Univariate analysis, multivariable Cox regression, and Kaplan-Meier plots were used for a comprehensive analysis. RESULTS: A total of 3,582 first-time HLTx candidates (2,953 adults and 628 children) eligible for our analyses were enrolled into the study. A total of 1,322 adults (45%) and 209 children (33%) underwent HLTx. HLTx recipients had significantly improved 10-year survival for both adults and children in the recent era of 2007-2016 (hazard ratios = 0.58; 95% confidence interval: 0.46, 0.72; p < 0.001 for adults and hazard ratios = 0.52; 95% confidence interval 0.29, 0.92; p = 0.03 for children). CONCLUSIONS: The landscape of HLTx has evolved over the past 40 years with significant improvement in survival occurring over time. Although a rare surgical procedure, HLTx continues to serve as a life-saving treatment option for a select patient population.