Current Transplantation Outcomes For Fontan Patients Including Multi-organ & Vad Therapy
Spencer Hogue, BS, Amalia Guzman-Gomez, BS, Katerina Boucek, MD, Chet Villa, MD, Clifford Chin, MD, Angela Lorts, MD, MBA, Jason W. Greenberg, MD, Farhan Zafar, MD, MS, David G. Lehenbauer, MD, David S. Winlaw, MBBS, MD, FRACS, David L. S. Morales, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objective: With increasing numbers of Fontan patients surviving into adulthood, a significant proportion are presenting with end-stage heart failure. Outcomes following heart transplant in Fontan patients are not well described and in several reports, outcomes have been less than ideal . We sought to analyze our institutional experience with heart transplantation in Fontan patients.
Methods: All patients with Fontan palliation undergoing transplantation were identified using the institutional database from 2013-2022. Included were en-bloc heart-liver transplantation, established in 2019.
Results: 26 patients were included, 20(76%) were male, 18(69%) <18yo (median age:14.1 [9.7-20.8], and 8(31%) were non-white. Pre-transplant patient characteristics (Table-1). Six (23%) patients were bridged with a SVAD [Support time:1mo, 2mo, 3mo, 4mo, 17mo, 36mo]. Transplant occurred at a median of 10.6yrs [6.3-15.7] post-Fontan. Five (19%) patients underwent en-bloc heart-liver transplant. The post-transplant rate of reintubation was 23%, delayed chest closure 15%, chest re-exploration for bleeding 23%, ECMO 7.6%, and rejection 19%. Hospital survival was 92%. Five deaths occurred at (22d, 2.9mo, 5.4mo, 3.1yr, 7.1yr). Median follow-up post-transplant: 2.2yrs [0.47-3.29]. Overall survival was excellent with 85% survival rate at 1- and 5-years post-transplant.
Conclusions: Given the natural history of Fontan palliation and numbers of patients entering the single ventricle pathway, there is a growing number of Fontan patients that may require transplantation. This single center cohort study demonstrates that excellent post-transplant outcomes are possible.
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