title: Cardiac and multiorgan transplantation for end-stage congenital heart disease.
abstract: OBJECTIVE
  To report our single-center experience with patients who had cardiac and multiorgan transplantation for end-stage congenital heart disease (CHD).
  
  
  METHODS
  We reviewed records for all patients with CHD who had undergone heart transplantation at Mayo Clinic, Rochester, Minnesota, from November 1, 1990, through June 30, 2012. Patients with cardiomyopathy were excluded, unless CHD was present.
  
  
  RESULTS
  Overall, 45 patients had cardiac transplantation for end-stage CHD (mean age, 26.1±18.4 years; range, 1 month to 65 years). Two patients (4%) had combined heart/liver transplantation; 1 (2%) had heart/kidney transplantation. Six patients (13%) had no previous cardiac operation; the remaining 39 patients had a mean of 3 (range, 1-8) previous cardiac operations. Patient survival (95% CI) at 1, 5, and 10 years was 89% (80%-98%), 89% (80%-98%), and 72% (56%-87%), respectively, while graft survival at 1, 5, and 10 years was 89% (80%-98%), 89% (80%-98%), and 61% (44%-78%), respectively. During the same era, the International Society for Heart & Lung Transplantation reported that survival in patients undergoing transplant for non-congenital diagnoses was 85%, 72%, and 56%, respectively. Over a mean follow-up of 8.7±6.2 years, rejection requiring treatment was documented in 35 patients (78%). Eleven patients (24%) have been diagnosed with neoplasia (8 skin, 1 blood, 1 lymph, and 1 other), and 3 patients (7%) have required retransplantation. Four patients (9%) have developed significant coronary vasculopathy; 1 successfully underwent retransplantation, and 3 died 6, 8, and 14 years after transplantation.
  
  
  CONCLUSIONS
  With appropriate patient selection and posttransplant monitoring, survival has improved for patients with complex end-stage CHD. Multiorgan transplantation is an option for selected patients with CHD.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Robinson
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN.
authors.forename: David J
authors.initials: DJ
authors.lastname: Driscoll
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: O'Leary
authors.affiliation: Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.affiliation: Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.affiliation: Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Brooks S
authors.initials: BS
authors.lastname: Edwards
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Sonja H
authors.initials: SH
authors.lastname: Dahl
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN. Electronic address: johnson.jonathan@mayo.edu.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Johnson
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008910:Minnesota; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult