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The University of North Carolina Heart-Lung Transplant Experience: Historical Perspective and Notes on Surveillance for Very Long-Term Survivors

Audrey L. Khoury, MD, MPH1, Eric G. Jernigan, MD2, Jennifer S. Nelson MD, MS3, Paula D. Strassle, PhD1,4, Vincent J. Gonzalez, MD5, Luma Essaid, MD6, Muntasir H. Chowdhury, MD7, Jason M. Long, MD, MPH1 , Mahesh S. Sharma*1 , MD

Background: The University of North Carolina (UNC) pioneered heart-lung transplant (HLT) in the state of North Carolina in 1991. Specific guidelines for surveillance of very long-term survivors of HLT are non-existent. We report historical context for the UNC 30-year experience with HLT, complexity of subsequent medical care, and a standardized approach to follow-up.

Methods: The medical and UNOS records for all patients who underwent HLT at UNC were reviewed. Demographics, perioperative details, and post-transplant medication regimens were abstracted. Early (30 day) and late (>30 days post HLT) morbidity was described, and Kaplan-Meier curves estimated long-term survival.

Results: Overall, 15 patients (67% male, 73% adults) underwent HLT, and 80% had congenital heart disease. Five-, twenty-, and twenty-five-year survival was 40% (n=6), 27% (n=4), and 20% (n=3), respectively. All 15-year survivors (n=5) experienced late complications (infections-100%; chronic kidney disease-60%; malignancies-40%; and pulmonary allograft rejection-60%). None had cardiac graft rejection.

Dedicated transplant cardiologists and pulmonologists directed long-term care, and survivors were followed every 6-12 months with non-invasive cardiopulmonary testing. Invasive testing with cardiac catheterization and/or bronchoscopy was performed every 2-3 years.

Limitations: Limitations of the study include small sample size typical of a single-center study. However, this historicallysignificant series represents the entire HLT experience at UNC.

Conclusion: UNC pioneered HLT in the state of North Carolina in 1991. HLT remains a rarely-performed, but viable option for end-staged cardiopulmonary failure as evidenced by favorable long-term survival. Late complications are common and warrant close surveillance and ongoing coordinated care by a specialized multi-disciplinary team.