Outcomes in adult congenital heart disease patients undergoing heart transplantation: A systematic review and meta-analysis.
Doumouras BS, Alba AC, et al.Journal of Heart & Lung Transplantation 2016; 35(11): 1337-1347.
Aims
To conduct a systematic review and meta-analysis comparing post- transplant outcomes in adult transplant recipients with congenital heart disease (CHD) to non-CHD recipients.
Interventions
The databases MEDLINE, Embase, and CINAHL were searched up until October 2013, and additional studies were identified from references of included sources and expert recommendations. Observational studies comparing post-transplant outcomes in adult CHD and non-CHD patients were selected for inclusion by two independent reviewers.
Participants
13 retrospective, unmatched cohort studies were included consisting of 899 CHD and 43,452 non-CHD patients.
Outcomes
The primary outcome measured was thirty-day mortality. Secondary outcomes measured were one-year mortality, five-year mortality and ten-year mortality.
Follow-up
The studies were unclear about length of follow-up.
CET Conclusions
There is much to commend this systematic review: the number of databases searched, the duplicate extraction of data, the high degree of reviewer agreement when monitored. The authors have also attempted to address duplicate information in overlapping studies, although probably without 100% success. The study showed that only low to very low quality evidence was available though. The studies included indicated that heart transplantation for congenital heart disease was significantly associated with higher 30-day mortality than heart transplantation for non-congenital heart disease (17% versus 7%). In part, due to a higher risk of bleeding, primary graft failure and stroke. Although the higher bleeding risk was not associated with a higher risk of reoperation. Interestingly, heart transplantation for congenital heart disease was associated with a significantly improved 10-year survival compared to heart transplantation for non-congenital heart disease (40% versus 49%). This was possibly due to the younger ages of patients in the congenital heart disease group, with lower risk of malignancy, infection and allograft vasculopathy. Subgroup analysis showed that patients with a previous Fontan/Glenn procedure accounted for all the increased risk in heart transplantation for congenital heart disease.
Quality notes
Quality assessment not appropriate
Trial registration
None