The objective of this study is to evaluate survival for combined heart-lung transplant (HLTx) recipients across 4 decades at a single institution. We aim to summarize our contemporary practice based on more than 271 HLTx procedures over 40 years. Data were collected from a departmental database and the United Network for Organ Sharing. Recipients younger than age 18 years, those undergoing redo HLTx, or triple-organ system transplantation were excluded, leaving 271 patients for analysis. The pioneering era was defined by date of transplant between 1981 and 2000 (n = 155), and the modern era between 2001 and 2022 (n = 116). Survival analysis was performed using cardinality matching of populations based on donor and recipient age, donor and recipient sex, ischemic time, and sex matching. Between 1981 and 2022, 271 HLTx were performed at a single institution. Recipients in the modern era were older (age 42 vs 34 y; < .001) and had shorter waitlist times (78 vs 234 days; < .001). Allografts from female donors were more common in the modern era (59% vs 39%; = .002). In the matched survival analysis, 30-day survival (97% vs 84%; = .005), 1-year survival (89% vs 77%; = .041), and 10-year survival (53% vs 26%; = .012) significantly improved in the modern era relative to the pioneering era, respectively. Long-term survival in HLTx is achievable with institutional experience and may continue to improve in the coming decades. Advances in mechanical circulatory support, improved maintenance immunosuppression, and early recognition and management of acute complications such as primary graft dysfunction and acute rejection have dramatically improved the prognosis for recipients of HLTx in our contemporary institutional experience.

中文翻译：

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心肺移植四十年的进展：单一机构271例

本研究的目的是评估单个机构 4 年来心肺联合移植 (HLTx) 接受者的生存情况。我们的目标是根据 40 年来超过 271 个 HLTx 程序总结我们的当代实践。数据是从部门数据库和器官共享联合网络收集的。年龄小于 18 岁的接受者、接受重做 HLTx 或三器官系统移植的接受者被排除在外，留下 271 名患者进行分析。开拓时代的定义是移植日期在 1981 年至 2000 年之间（n = 155），现代时代的定义是 2001 年至 2022 年之间（n = 116）。使用基于供体和受体年龄、供体和受体性别、缺血时间和性别匹配的群体基数匹配进行生存分析。 1981 年至 2022 年间，单个机构进行了 271 次 HLTx。现代的接收者年龄较大（42 岁 vs 34 岁；< .001），并且等待时间较短（78 天 vs 234 天；< .001）。来自女性捐赠者的同种异体移植在现代更为常见（59% vs 39%；= .002）。在匹配生存分析中，30 天生存率（97% vs 84%；= .005）、1 年生存率（89% vs 77%；= .041）和 10 年生存率（53% vs 26%；= .041）。 = .012）在现代相对于开拓时代分别有显着改善。 HLTx 的长期生存是可以通过机构经验实现的，并且可能在未来几十年内继续改善。根据我们当代机构的经验，机械循环支持、改善的维持性免疫抑制以及早期识别和处理原发性移植物功能障碍和急性排斥反应等急性并发症方面的进展，极大地改善了 HLTx 受者的预后。