title: Heart transplantation for adults with congenital heart disease: results in the modern era.
abstract: BACKGROUND
  Heart transplantation in adults with congenital heart disease (CHD) has historically been associated with sub-optimal survival compared with other indications for transplantation. The purpose of this study was to evaluate survival outcomes after heart transplantation in a contemporary cohort of adults with CHD and to identify risk factors for mortality that may help guide recipient and donor selection.
  
  
  METHODS
  We performed a retrospective analysis of our adult heart transplant database, from January 2001 to February 2011, identifying 19 patients who underwent transplantation for CHD. These patients were compared with a control group of 428 patients who underwent transplantation for indications other than CHD. Kaplan-Meier survival analysis and Cox regression modeling were performed.
  
  
  RESULTS
  The mean age for the CHD group was 39.4 ± 13 years vs 54.7 ± 12 years (p < 0.001). There was no significant difference in survival (CHD vs control) at 30 days (89% vs 92%, p = 0.5567), 1 year (84% vs 86%, p = 0.6976) or 5 years (70% vs 72%, p = 0.8478). The only significant predictor of death in the CHD group was donor organ ischemic time >4 hours (HR 13.26, 95% CI 1.3 to 132.2, p = 0.028). There was no significant correlation with recipient age, history of failed Fontan surgery, pre-operative ventilator use, donor:recipient weight ratio <0.8, donor:recipient CMV mismatch, model for end-stage liver disease (MELD) score or percent reactive antibody >10%.
  
  
  CONCLUSIONS
  In the modern era, with careful donor and recipient selection, adults with CHD have excellent early and mid-term survival after heart transplantation, rivaling that of recipients with other indications for transplantation.
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. bhamajk@upmc.edu
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.forename: Joshua
authors.initials: J
authors.lastname: Shulman
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Aditya
authors.initials: A
authors.lastname: Bansal
authors.forename: Ravi
authors.initials: R
authors.lastname: Ramani
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Teuteberg
authors.forename: Michael
authors.initials: M
authors.lastname: Shullo
authors.forename: Dennis M
authors.initials: DM
authors.lastname: McNamara
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome