Transplantation for pulmonary arterial hypertension with congenital heart disease: Impact on outcomes of the current therapeutic approach including a high‐priority allocation program. Issue 10 (5th August 2021) - Hascoët, Sébastien
Abstract : Patients with end‐stage pulmonary arterial hypertension due to congenital heart disease have limited access to heart‐lung transplantation or double‐lung transplantation. We aimed to assess the effects of a high‐priority allocation program established in France in 2007. We conducted a retrospective study to compare waitlist and posttransplantation outcomes before versus after implementation of the high‐priority allocation program. We included 67 consecutive patients (mean age at listing, 33.2 ± 10.5 years) with pulmonary arterial hypertension due to congenital heart disease listed for heart‐lung transplantation or double‐lung transplantation from 1997 to 2016. At one month, the incidences of transplantation and death before transplantation were 3.5% and 24.6% in 1997–2006, 4.8% and 4.9% for patients on the regular list in 2007–2016, and 41.2% and 7.4% for patients listed under the high‐priority allocation program ( p < .001 and p = .0001, respectively). Overall survival was higher in patients listed in 2007–2016 (84.2% and 61.2% at 1 and 10 years vs. 36.8% and 22.1%, p = .0001). Increased incidence of transplantation, decreased waiting list mortality, and improved early and long‐term outcomes were observed in patients with pulmonary arterial hypertension due to congenital heart disease listed for transplantation in the recent era, characterized by implementation of a high‐priority allocation program. Abstract : A retrospective study shows that high‐priority allocation program increases transplantation, decreases waitlist mortality, and improves outcomes for patients with end‐stage pulmonary arterial hypertension due to congenital heart disease.