• Stefan Elde, Basil M Baccouche, Danielle M Mullis, Matthew M Leipzig, Tobias Deuse, Aravind Krishnan, Moeed Fawad, Reid Dale, Sabrina Walsh, Amanda Padilla-Lopez, Brandon Wesley, Hao He, Shin Yajima, Yuanjia Zhu, Hanjay Wang, Brandon A Guenthart, Yasuhiro Shudo, Bruce A Reitz, and WooY JosephYJDepartment of Cardiothoracic Surgery, Stanford School of Medicine, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif. Electronic address: joswoo@stanford.edu..
• Department of Cardiothoracic Surgery, Stanford School of Medicine, Stanford University, Stanford, Calif.
• J. Thorac. Cardiovasc. Surg. 2024 Aug 1; 168 (2): 581592.e4581-592.e4.

ObjectiveThe 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.MethodsData 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.ResultsBetween 1981 and 2022, 271 HLTx were performed at a single institution. Recipients in the modern era were older (age 42 vs 34 y; P < .001) and had shorter waitlist times (78 vs 234 days; P < .001). Allografts from female donors were more common in the modern era (59% vs 39%; P = .002). In the matched survival analysis, 30-day survival (97% vs 84%; P = .005), 1-year survival (89% vs 77%; P = .041), and 10-year survival (53% vs 26%; P = .012) significantly improved in the modern era relative to the pioneering era, respectively.ConclusionsLong-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.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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