Trends and Outcomes of Heart Transplantation in Adults With Congenital Heart Disease

Heart transplantation for adult congenital heart disease (ACHD) is associated with challenging pretransplant support, long waitlists, and high early post-transplant mortality. The authors used 2,737 patients from the United Network for Organ Sharing database to examine whether changing practices have altered outcomes in the period from 1992 to after 2018, when the allocation system changed. The listed and transplanted patients gradually increased, but the proportion receiving a transplant remained constant. There were decreases in both the proportion delisted or dying after listing and the waitlist times, especially after 2018. Mortality at 30 days post-transplant remains high but has significantly improved. The authors concluded that more complex patients do not have worse outcomes and that the new donor allocation system has reduced wait times without affecting early mortality.