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Transplantation: the final hurdle to longevity in patients with congenital heart disease
  1. Peter N Ruygrok
  1. Correspondence to Peter N Ruygrok, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland 1030, New Zealand; PRuygrok{at}adhb.govt.nz

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Heart transplantation (HT) is an established treatment for patients with end-stage heart disease in whom all other management options have been exhausted, providing excellent functional capability and a good median-term survival, now exceeding 12 years.1 The two most common causes of heart failure in those undergoing HT are dilated cardiomyopathy (50.5%) and ischaemic heart disease (33.1%).1 Those with congenital heart disease (CHD) form 3.1% of patients reported to the international registry in recent years.1

There are accumulating data indicating that children now born with CHD have an increased chance of living to adolescence, adulthood and even middle age. More than 90% of patients born with CHD are now expected to survive into adulthood2 with an estimated prevalence of CHD in adults of approximately 3000 per million population.3 These patients have benefited from advances in surgical technique and medical therapy, delaying the onset of univentricular or biventricular failure, arrhythmias, pulmonary hypertension and multiorgan failure to an older age.4 Not only does this growing population increase the need for HT but also adds to the diversity and complexity of transplant surgery and immediate postoperative care.

In their Heart paper, Dimopoulos and colleagues report the English experience of HT and combined heart/lung transplantation (HLT) in patients with CHD.4 Over an 18-year period, 469 transplants were performed in 444 patients—with most (82.2%) isolated HT. Based on previous trends, the authors provide a forecast of expected numbers of transplants in patients with CHD over the next 10 years, with a predicted increase of approximately one third. This number lags well behind the need suggested by the rapid increase in patients with CHD requiring repeated hospitalisations for advanced heart failure.4

Barriers to transplantation in patients with CHD

Limited donor numbers

The number of HTs reported to the international registry, which is estimated to be 80% of those performed …

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