Heart and lung transplants hampered by donor shortages and unchanged death rates

Optimism about the success of heart and lung transplants at the start of the 1990s is not supported by the evidence, shows an audit of the procedure, published in Heart.

Transplants continue to be hampered by the high death rates after surgery and a shortage of suitable donors, finds the study. Almost half of those waiting for a lung transplant will not receive one, and at least a quarter will die within two years of being listed.

All nine UK units performing heart, lung, or heart and lung transplants, were included in the audit of procedures carried out between 1995 and 1999. During that time 2588 patients were added to the waiting list – 5 per cent of heart patients were children under the age of 8; 1737 of the total were given a transplant.

Within six months of listing, just over half the heart transplant patients had been given a new heart, but 11 per cent had died while waiting. Just over a third of those needing a lung transplant had received one, but 15 per cent had died waiting, while 23 per cent of those needing a heart and lung transplant had been given one, but one in five had died while waiting.

Patients waiting for a combination procedure had the longest wait, averaging 471 days – well over double that for heart transplants alone. But the authors note that the number of heart donors fell during the study period.

Three years after listing, 36 per cent of heart and lung transplant patients, a third of lung patients, and 17 per cent of heart patients, had died while waiting for a transplant.

The new organ did not work in half of the 129 heart patients who died after their transplant. The highest risk of death was in the first month after surgery, with infections and rejections also common causes of death during this time.

Three quarters of heart patients were still alive three years after surgery. Only just over half the lung transplant patients survived this long. These figures are in line with data from other centres around the world. But International registry data indicate that the outcomes for heart transplant patients have changed little since 1986, and those for lung transplant patients have remained the same since 1991.

The authors conclude that considerable efforts need to be made to enlarge the pool of suitable donors and minimise the risks of early death after surgery if these outcomes are to be improved. It is also crucial to identify more effectively those patients who would benefit from a transplant.