Heart-Lung Transplantation: A Viable Option for Systemic Sclerosis

Abstracts S139 Methods: From June 1992 to August 2015 we performed 83 combined HKTx procedures at our institution. We compared our initial 30 previouslyreported HKTx recipients (Group 1, June 1992 - February 2009) to a more recent cohort of 53 HKTx recipients (Group 2, March 2009 - August 2015). Preoperative patient characteristics, perioperative factors, and postoperative outcomes including survival were examined. Results: Group 2 had higher pre-operative left-ventricular ejection fraction (LVEF), cardiac output (CO) and index (CI), a lower left-ventricular end-diastolic diameter (LVEDD), and more diabetics compared to Group 1 (p= 0.005, 0.018, 0.007, 0.049, and 0.028, respectively). The pump time and graft ischemic time were longer in Group 2 compared to Group 1 (153 ± 38.7 vs 131 ± 37.1, p= 0.009 and 195 ± 45.1 vs 176 ± 49.8, 0.037, respectively). However, the length of ICU and hospital stays were similar between both Groups (p= 0.075 and 0.39, respectively). In addition, pre-operative and post-operative creatinine levels at peak, discharge, 1 year and 5 years were similar between both Groups (p= 0.56, 0.68, 0.62, 0.67, and 0.43, respectively). Of note, the frequency of post-operative dialysis was similar as well (p= 0.139). Overall survival was not significantly different between Groups 2 and 1, respectively, at 30 days (96.2±2.6 vs 93.3±4.6, p= 0.62) and 60 days (96.2±2.6 vs 93.3±4.6, p= 0.62). At 5-years there was a trend to higher survival in Group 2 (93.4% ± 3.8% vs 70.0% ± 8.4%, p= 0.051). There were only 3 deaths in Group 2: at 4, 6, and 289 days post-operatively, but the mean follow-up time was shorter (2.0±1.8 vs 8.3±6.0 years, p< 0.0001). Conclusion: Our institution is performing an increasing number of HKTx procedures on more diabetic patients with higher LVEF, CO, and CI, and a lower LVEDD, while reaching a similar ICU and hospital length of stays and post-operative creatinine levels at peak, discharge, 1 year and 5 years, frequency of post-operative dialysis in the later cohort of patients (March 2009 - August 2015). Overall survival at 30 and 60 days were similar in the two Groups, and there was a trend to higher overall survival at 5 years in the most recent cohort. HKTx is safe to perform in a selected patients with combined heart and kidney failure. 3( 56) Heart-Lung Transplantation for Congenital Heart Disease: A 25 Years Single Center Experience D. Bobylev ,1 J. Salman,1 W. Sommer,1 I. Tudorache,1 F. Ius,1 T. Siemeni,1 C. Kuehn,1 M. Avsar,1 C. Bara,1 A. Horke,1 D. Boethig,1 N. Schwerk,2 J. Gottlieb,3 A. Haverich,1 G. Warnecke.1  1Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; 2Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany; 3Pulmonary Medicine, Hannover Medical School, Hannover, Germany. Purpose: Combined heart-lung transplantation has rendered unfashionable in recent years. However, the small, yet distinguished cohort of patients with congenital heart disease (CHD) and Eisenmenger’s reaction prevails as indication. Here, we wished to analyze our single center experience in this type of transplantation. Methods: Since January 1988, a total of 150 heart-lung transplantations have been performed at our institution. A retrospective study identified patients that underwent heart-lung transplantation for congenital heart disease. Results: A total of 89 heart-lung transplantations have been performed between January 1988 and September 2014 in patients with CHD. There were 51 female and 36 male, with a mean age of 35±11.7 (9-52) years. The indication for transplantation was Eisenmenger’s disease and end stage CHD. The most common underlying diagnosis was ventricular septal defect (n= 32, 37%). Other diagnoses were: transposition of the great arteries (n= 12, 14%), pulmonary atresia (n= 9, 10%), persistent ductus arteriosus (n= 6, 7%), truncus arteriosus (n= 6, 7%), tetralogy of Fallot/Double Outlet Right Ventricle (n= 5, 6%) and other (n= 17, 19%). Eighteen patients (20%) had undergone previous cardiac surgical procedures. Three patients required additional surgical procedures at the time of transplantation (repair of aortic coarctation, n= 1; renal transplantation, n= 1; atypical lung resection, n= 1). Two patients were later re-transplanted (lungs only) for BOS. Maximal follow up was 25 years. Patient survival was estimated with the Kaplan-Meier method. The actuarial survival rate was 63±6% at 10 years and, 61±6% at 20 years. There was no significant difference compared to mortality of the other patients after combined heart-lung transplantation for other underlying diseases (idiopathic

pulmonary artery hypertension patients (IPAH): 10 years survival is 65±7%, 20 years survival is 58±9%). Conclusion: Combined heart-lung transplantation can be performed with elevated but acceptable procedural risk und favorable long-term outcome in patients with congenital heart disease. 3( 57) Heart-Lung Transplantation: A Viable Option for Systemic Sclerosis L.K. Stern , R.G. Kiel, M. Janmohamed, L. Klein, T. De Marco, V.N. Selby.  Cardiology, University of California, San Francisco, San Francisco, CA. Purpose: Systemic Sclerosis (SSc) is an autoimmune connective tissue disease that can involve the heart and lung. Cardiac abnormality can stem from pulmonary hypertension or primary cardiac disease. While lung transplantation (LTx) has been effective for patients (pts) with pulmonary involvement, it is unknown how outcomes of heart-lung transplantation (HLTx) compare to LTx. The aim of this study is to evaluate HLTx utilizing a US national database. Methods: HLTx pts from 2000-2014 reported by the UNOS database were assessed and compared to both LTx pts with SSc and HLTx pts for all other indications (HLTx-OI). The primary outcome was all cause mortality. 1 and 4-year survival was determined using the Kaplan Meier method. Risk factors for survival (adjusted for recipient age/gender, donor age, ischemia time, heart transplant status) were analyzed using multi variable Cox proportional hazard regression. The secondary endpoint was freedom from 1st year rejection. Results: 430 of 21,928 LTx (1.96%) and 8 of 466 HLTx (1.72%) pts had a primary indication of SSc. Demographics (recipient age/gender, donor age, time on the waiting list, CMV mismatch) between the 2 comparison groups were similar. Ischemic time was lower for HLTx-SSc (3.80 hrs) v. LTx-SSc (5.31 hrs) (p =  0.012). Status 1 was more common for HLTx-SSc (1A 25%, 1B 75%) v. HLTx-OI (1A 34%, 1B 20%) (p=  0.011). 1 and 4-year survival was lower but not significantly different between HLTx-SSc v. LTx-SSc as well as compared to HLTx-OI (Table). Freedom from 1-year rejection was not significantly different among the two comparison groups. Conclusion: SSx is a rare indication for HLTx as well as LTx (< 2%). Review of national data confirms that, despite being somewhat sicker at the time of transplant as evidenced by a higher rate of Class 1 status, outcomes of HLTxSSc pts are similar to that for LTx and HLTx-OI with respect to survival and freedom from rejection. HLTx appears to be a viable option for pts with SSc and significant cardiac involvement.

Outcomes for HLTx-SSc v. LTx-SSc and HLTx-OI Outcomes

HLTx-SSc

LTx-SSc

p-value1

HLTx-OI(%) p-value2

1-Year Survival 4-Year Survival Freedom from 1-Year Rejection

100.00% (8/8) 83.33% (7/8) 71.43% (5/7)

78.60% (344/430) 56.07% (281/430) 70.50% (196/278)

0.19

71.82% (331/458) 51.60% (252/458) 66.22% (198/299)

0.96

0.13

0.77

1-Comparison 1: HLTx-SSc v. LTx-SSc 2-Comparison 2: HLTx-SSc v. HLTx-OI

3( 58) Repeated Levosimendan Infusions in Refractory Heart Failure. Single Center Experience. E. Perna , E. Ammirati, F.M. Turazza, M. Cipriani, L. D’Angelo, G. Foti, A. Garascia, F. Macera, G. Masciocco, M. Frigerio. A.  DeGasperis CardioCenter, Niguarda-Ca’ Granda Hospital, Milan, Italy. Purpose: Levosimendan (LEVO) is a calcium sensitizer with inotropic and vasodilator properties, which effects persist beyond the infusion time due to