title: Examining Mortality and Rejection in Combined Heart-Lung Transplantations.
abstract: BackgroundThere 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.MethodsThe 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.ResultsMultivariable 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.ConclusionSurvival 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.
authors.affiliation: Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States.
authors.forename: Sagar
authors.initials: S
authors.lastname: Kadakia
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: Senthil
authors.initials: S
authors.lastname: Jayarajan
authors.affiliation: Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Ambur
authors.affiliation: Department of Cardiac Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States.
authors.forename: Grayson
authors.initials: G
authors.lastname: Wheatley
authors.affiliation: Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States.
authors.forename: Larry
authors.initials: L
authors.lastname: Kaiser
authors.affiliation: Department of Cardiac Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003586:Cytomegalovirus Infections / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States